Nancy Pares, RN, MSN Metropolitan Community College Nursing Program.

Nurs 1110 Care of the Older

ClientNancy Pares, RN, MSN

Metropolitan Community College Nursing Program

Most definitions= having lived a long time Aged: old or advanced in years Aging: process of growing older

We all age: not all are old in years, roles, behaviors, health or physical limitations

Aging is an ongoing developmental process that begins with conception and ends with death

Definitions of Old Age

Study of aging

Geriatrics◦ The biomedical science of old age and the

application of knowledge related to the biological, biomedical, behavioral, and social aspects of aging to the prevention, diagnosis, treatment, and care of the older persons.

Gerontology

Clinical: older adult age 65 or older Older-old adults: age 85 or older

◦ 1996 33.2 million over 65, 3.8 million >85◦ 2010-2030: baby boomers reach old age

Three generations are affected by aging◦ Parents, grandparents, great grandparents

Terminology of Today

Systematic stereotyping and discrimination Allows for separation and denial of the older

person’s humaness Allows those who practice ageism to

distance themselves from their own aging

Ageism

Socioeconomic and cultural factors◦ Roles: jobs, empty nest, spouse dies◦ Personal relationships: children live away, friends

die◦ Health: > chronic illness, ‘slow down’◦ Agility: flexibility, CNS reactions slow◦ Financial: medicare, fixed income◦ Employment: must retire◦ Independence: loss

Aging Process

Non productive Disengaged Inflexible Senile Not able to learn new things Retirement causes death Sexless Poor, disabled, ill…..

Myths of aging

Think about movies you have seen….

Think about an older relative

Visualize magazine pictures of the ‘50’s and compare to present

Describe an older adult

Physiologic Changes in Body

In the absence of disease, most aged are alert with full functional capability

Modest impairments in memory and learning after the age of ___?__ in people free of major disease.

Short term memory, progressive slowing of responses

Nervous system

Long term memory remains intact◦ Dependent on adequate O2 perfusion

May not remember planned daily activities—easily recalls childhood

Mild cognitive impairment (MCI)◦ 40% will develop Alzheimer’s disease within 3

years

Nervous system

Strategies to cope◦ Mnemonics◦ Behavioral memory training

Temperature regulation◦ Low tolerance to ______

Pain perception and tactile perception◦ Some research have found dulling, but these

results are not consistent

Nervous system

If acute disease is causing delirium, re-orient client

Depression◦ Assess and provide for treatment◦ Suicide rate high in elderly population

Assess for TIA Monitor BP Medicate as ordered

CNS interventions

Forced vital capacity, vital capacity and max breathing capacity decreases with age◦ Atrophy of muscles◦ Increase in diameter of chest◦ Vertebral loss of calcium◦ Calcification of costal cartilage

Respiratory

Loss of elastic tissue around alveoli and alterations in pulmonary circulation---decreased diffusion across the alveolar capillary membrane

Pulmonary blood flow◦ Decreases due to reduction in cardiac output

Respiratory

Exertional dyspnea◦ Shortness of breath with exertion◦ Ability to perform prolonged strenuous work

decreases with aging Lung disease

◦ Poses a threat to older adult◦ Pulmonary secretions are handled less effectively

Respiratory

Pneumonia vaccine Influenza vaccine Avoid distended bowel/bladder or

stomach Allow adequate time for cares Medications as needed Adequate hydration Lung sounds

◦ Proper breathing patterns-pursed lip breathing for COPD

Respiratory nursing interventions

Blood flow resistance increases as people age

Aging results in sclerosis of the endocardium

Heart becomes rigid-contractility impaired

Cardiovascular

Coronary blood flow reduced by 35% Valvular rigidity results in murmurs Heart cells have decreased capacity to use

oxygen Pulse increases and the pulse pressure

widens

Cardiovascular

Decrease in resting cardiac output◦ Amount of blood pumped each minute◦ Between age 25 and 65 the resting CO falls 30-

40%◦ Cerebral blood flow is maintained, but other body

systems receive a diminished blood supply

Cardiovascular

Peripheral vascular disease (PVD) Hypertension Chronic CHF (congestive heart failure)

Common CV problems

Assess peripheral pulses Evaluate lifestyle factors Teach about disease and treatment Evaluate diet Evaluate need for fluid restrictions Teach about BP monitoring Monitor BUN and creatine Teach about need for exercise

General nursing interventions

Decrease in function, cell mass and increase in extracellular fluid

Decrease in filtration rate, plasma flow rate, tubular reabsorption and secretion

Blood urea nitrogen (BUN) increases Ability to concentrate or dilute urine is

diminished Bladder capacity reduces by half

Renal

Response to the stretch receptors in the bladder wall that signal need to void may be delayed until the pressure is high

Lax muscle tone may lead to incomplete emptying◦ Residual volume may lead to UTI

Renal

Incontinence◦ Conservative behavior treatment is first line

therapy◦ Prostate enlargement

Renal

Assessment for bladder management Peri care MD referral for treatment options Allow voicing of concerns Do not allow self limitation of fluids

Renal nursing interventions

Skin changes can be the most distressing Dryness, loss of elasticity, uneven

pigmentation Wrinkles

◦ Occurs when deep layer of skin loses moisture and elasticity

◦ Can be determined by genetics and sun exposure

Integumentary

Certain ethnic groups may maintain youthful appearance

Itching◦ Related to loss of oils in skin◦ Tepid baths◦ If persists, contact MD

Hair loss Nails

Integumentary

Skin assessment for pressure ulcers, or lesions

Adequate diet and fluids Dry skin is vulnerable to break down

Integumentary nursing interv.

Oral cavity◦ Decrease in taste bud function◦ Deterioration of teeth◦ Decrease in saliva

Muscles associated with chewing weaken Peristalsis is slower Gastric emptying is slower

Gastrointestinal

Glands secrete less volume and concentration of hydrochloric acid

Gag reflex decreases Gastric emptying slows Liver size decreases after age 70 Liver enzymes decrease Less Calcium is absorbed

Gastrointestinal

Constipation◦ Frequent GI complaint due to slowed motility,

altered bacterial flora, medications and lack of exercise

Common GI problems◦ Over or under nutrition◦ Constipation or diarrhea◦ Dehydration◦ Dental disorders

Gastrointestinal

General nursing interventions◦ Assess nutritional status◦ Teach about proper nutrition◦ Inform about community resources◦ Assess fluid intake/output◦ Assess use of laxatives◦ Inform about benefits of exercise◦ Teach about oral hygiene

Gastrointestinal

Muscle mass and elasticity decrease Bone demineralization Joints undergo degenerative changes Less endurance ROM changes Coordination changes

Musculoskeletal

Arthritis◦ Most prevalent in men◦ More severe in women◦ Leading cause of disability

Osteoarthritis◦ Most common form of arthritis◦ Caused by damage to the inside of joint surface◦ Large wt bearing joints most affected

musculoskeletal

Kyphosis◦ Curvature of thoracic spine

Teach benefits of weight bearing exercise◦ Walking, biking, …◦ Assistive devices to prevent falls◦ Avoid prolonged bedrest

musculoskeletal

Nursing interventions◦ Adequate Ca, pro- and vitamin D◦ Avoid smoking, alcohol◦ Estrogen replacement for females◦ Safety of environment◦ Pain control◦ Exercise◦ Correct use of assistive devices◦ Complications of surgery

musculoskeletal

Presbycusis◦ Hearing loss◦ 25% of adults over 69 and 50% >85 have hearing

loss◦ Conduction deafness

Blockage of ear canal caused by cerumen, infection or abnormal structure

◦ Sensorineural Damage to nerve tissue from exposure to loud

noises, disease, certain drugs

Sensory System

Macular degeneration◦ Affects the macula which is responsible for sharp

central vision Cataract

◦ Clouding or opacity of normal transparent lens◦ Surgical removal of the clouded lens

Sensory

Presbyopia◦ Affects the shape of the lens◦ Close work becomes difficult

Glaucoma◦ Atrophy of the optic nerve due to increased

pressure of the fluid in the eye

sensory

General nursing interventions◦ Assess ears for abnormalities◦ Evaluate medications for ototoxicity◦ Regular hearing tests◦ Monitor care of hearing aid◦ Instruct family on socialization and

communication needs of the elderly

sensory

Reduce clutter◦ Rugs, cords, furniture

Vision◦ Glasses, lighting

Reaching distance Non skid shoes, walkers, canes Skin care Environmental temperature

Safety

Risk for falls increases with◦ Changes in position◦ Unstable equipment◦ Waxed floors◦ Improper placement of food trays◦ restraints

Safety

Most at risk◦ History of falls◦ Osteoporosis◦ Prior stroke or sensory impairment◦ Anticoagulation therapy◦ Parkinson’s disease◦ Diabetes with peripheral neuropathies

Safety

Movement toward Erikson’s ego integrity is facilitated with older person◦ Recognizes and accepts changes◦ Gives up roles and develops new ones◦ Develops a different self concept◦ Revises life goals

Functional Assessment

Positive◦ Rational actions, perseverance, positive thinking,

maintaining humor Negative

◦ Loss of identity, fulfillment, self esteem

Functional coping/adaptation

ADL (activities of daily living)◦ Environmental, financial, community resources

Assess the activities they do alone Assess what they need help with Functional assessment + diagnosis=

nursing interventions

Functional assessment

Basic◦ Grooming, bathing, dressing, eating, elimination,

mobility

Instrumental◦ Prepare meals, shop, use the telephone,

housekeeping

Functional assessment

88% of older adults use > 1 medication In long term care (LTC)

◦ >75% receive 4 or more meds◦ >33% receive 7 or more meds

Age slows the clearance of drugs and increases the risk of adverse effects

Drug therapy

Decreased liver size, hepatic blood flow and reduced enzyme activity

Polypharmacy Older adults respond more vigorously to

drugs that act on the CNS◦ Postural imbalance, uncoordinated movements,

respiratory depression, mental changes

Drug therapy

Nursing interventions◦ Monitor drug regimen

Amount, duration, purpose, ability to take◦ Monitor vital signs◦ Monitor/record drug effects◦ Describe client cooperation◦ Teach no OTC without MD approval

Drug therapy

Independent living Family provided assistance in home Home health care Assisted living facilities Long term care facilities

Housing and Health alternatives

Protein◦ Same unless ill then increase◦ 12-20% of daily intake

Carbohydrates◦ Decrease simple, increase complex◦ 55-60% of daily intake

Minerals◦ Decrease due to decrease in body mass◦ Increase Ca intake

water

Nutritional requirements