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2009-11-06 23:48:18
Chapter 91

Gerontology: The Aging Adult
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  1. Gerontology
    Study of effects of normal aging and age-related diseases
  2. Geriatrics
    Branch of medicine concerned with the problems and illnesses of aging and their treatment
  3. Gerontologic nursing
    Branch of nursing that assists people to age in a healthy manner and to promote and maintain wellness in late life
  4. Changes Related to Normal Aging Processes
    • *Decreased functioning of organs
    • *Changes in visual, auditory acuity
    • *Decreased reaction time
    • *Unsteady gait; decreased sense of balance
    • *Decreased tactile sensation
    • *Stiff joints
    • *Emotional, socioeconomic, physical losses
    • *Decreased capacity for recovery from wounds, injury, illness
  5. Care Settings for Older Adults
    • Development of plan of care for an older adult requires observation and an understanding of the person’s current lifestyle
    • *Ability for self-care
    • *Potential for rehabilitation
    • Factors determining the choice of residence for aging adult
    • *Physical, financial, emotional self-care needs
    • *Access to healthcare and rehabilitation services, transportation
    • *Need for protection and supervision
  6. Home Care
    • For aging adults with manageable conditions
    • *Current trend in healthcare is to provide needed care in the client’s home
    • *Services
    • **Home health aides
    • **Homemakers
    • **Therapy: occupational (OT), physical (PT), speech, respiratory
  7. Nutritional Needs
    • One third to one half of all health problems of older adults
    • *Relate directly or indirectly to inadequate nutrition and fluid intake
    • Balanced nutrition results in
    • *Increased energy; healthy mental outlook; rapid healing of surgical conditions with fewer complications
    • Older adults
    • *Absorb nutrients slowly; caloric needs reduced due to the slowing of metabolism
    • Excess weight can seriously affect self-esteem and health
    • Disorders related to obesity
    • *Diabetes mellitus, hypertension, myocardial infarction, stroke
    • *Back and joint pains; falling
    • Control weight
    • *Low-fat, low-calorie, nutrient-dense diet recommended
    • Special considerations
    • *Teeth and chewing
    • *Oral care and denture care facilitate eating success of edentulous clients
    • Swallowing difficulties
    • *Ensure food provided is of a consistency that the client can swallow
    • *Provide semisolid foods and thickened liquids
  8. Nutritional Needs: Special Considerations
    • For meals, elevate the head of the bed or have the client sit in a chair
    • *Cutting food into edible bites
    • **Enables client to chew easily
    • **Prevents choking
    • Difficulty swallowing or refusal to eat
    • *Use special adaptive techniques or suction apparatus
  9. Nursing Alert
    • *Observe for side effects when giving medications to older adults.
    • *The usual adult dose of an antidepressant is often toxic to the elderly person. In addition, any drug given to the older person may cause an effect opposite to that in a younger person (paradoxical effect).
  10. Nutritional Needs: Special Considerations, cont.
    • *Medications and supplements, cont.
    • *Vitamin deficiencies: affect nutritional status in older adults
    • *Excessive vitamins and minerals: harmful and expensive
    • *Teach: use of medications and supplements, drink adequate amounts of water
    • *Offer a variety of fluids; provide assistance to clients who are unable to consume fluids independently
    • *Older adults—less body fluid than younger persons, dehydrate very easily
  11. Nutritional Needs: Supplementing Oral Intake
    • Client who is ill and unable to eat and drink
    • *Provide alternate means of supplying nutrients
    • Three major types of mechanical nutrient supplementation
    • *Intravenous therapy
    • *Total parenteral nutrition
    • *Tube feedings
  12. Personal Hygiene Needs: Skin Care
    • Aging skin has few oils, is fragile
    • Daily bathing not necessary—can be harmful
    • Bed baths or sponge baths—alternative hygiene measures
    • Incontinent client
    • Keep skin clean and dry to prevent irritation and breakdown
    • Apply lotion
    • Keep client’s skin soft
    • Promote peripheral circulation
  13. Personal Hygiene Needs: Oral Hygiene
    • Encourage: care for the mouth
    • To prevent dental difficulties and halitosis
    • Assistance with oral care
    • Clients with arthritis, cerebrovascular accidents, altered mental status, other difficulties
  14. Nursing Alert
    • Encourage older people with dentures to check the condition of their gums regularly.
    • Irritation can result from poorly fitting dentures.
    • Cancer of the mouth sometimes occurs and may go undetected.
  15. Personal Hygiene Needs: Hair Care
    • Shampoo hair as needed
    • To promote comfort and cleanliness
    • Do not overdo shampoo: hair is often dry and brittle
    • Fresh hairdo or haircut: more positive self-image
  16. Key Concept
    Self-care of the hair is an excellent opportunity for active range-of-motion exercise
  17. Personal Hygiene Needs: Nail and Foot Care
    • Nails: cut straight across
    • Corns and calluses
    • Soak in warm water, never cut
    • Caring for client’s feet
    • Document injuries or discolored areas
    • Report to physician
  18. Nursing Alert
    Most healthcare facilities do not allow nurses to cut the toenails or fingernails of diabetic clients.
  19. Personal Hygiene Needs: Shaving
    • Self-esteem of older male clients
    • Benefits from regular shaving
    • Allow client to do as much for himself as possible
    • Assist when needed; be careful to prevent cuts
  20. Personal Hygiene Needs: Clothing
    • Aging adults
    • More clothing needed to maintain internal warmth
    • Allow residents of nursing homes
    • Wear their own clothes
    • Encourage clients to dress in street clothes each day
    • Encourage and assist women to apply cosmetics
  21. Elimination Needs: Constipation
    • Discourage excessive use of laxatives or enemas—disturb or eliminate normal urge to defecate
    • Encourage clients
    • Respond to urge to defecate as soon as possible
    • Nursing care in acute and long-term facilities
    • Daily monitoring of gastrointestinal function required
  22. Elimination Needs: Bladder or Bowel Incontinence
    • Older clients
    • Difficulty controlling bladder and bowel functions
    • Retraining; following a regular schedule is helpful
    • Treat incontinence situation with dignity and discretion
    • Provide assistance: cleaning skin, changing clothes
    • Evaluate incontinence to identify its cause
  23. Elimination Needs: Difficulty in Voiding
    • Fecal impaction
    • Common cause of urinary retention
    • Obtain
    • Accurate intake and output records—may need to monitor excretory status
    • Thoroughly cleanse skin
    • Prevent skin breakdown
  24. Helping the Older Adult Meet Emotional Needs
    • Psychological health
    • As important as physical health
    • Encourage client
    • Remain self-sufficient and mentally active
    • Maintain independence
    • Include clients in
    • Care planning and other activities
    • Provide opportunities to participate in decision-making
  25. Mental Health Concerns in Older Clients: Anxiety
    • Feeling of uneasiness or apprehension
    • Can result in
    • Withdrawal, isolation, confusion
    • Combative or maladaptive behaviors
    • Treatment
    • Determine level of client’s anxiety
    • Identify physical and emotional defense mechanisms
  26. Mental Health Concerns in Older Clients: Anxiety, cont.
    • Treatment, cont.
    • Remain calm
    • Provide outlets for excess energy
    • Answer questions honestly
    • Reassure client
    • Referral to a psychiatrist or other mental healthcare professional for evaluation and treatment
  27. Mental Health Concerns in Older Clients: Depression
    • Cumulative losses, numerous changes
    • Can lead to depression
    • Possible causes
    • Disease processes, side effects of medications, adjustment to life cycle changes
    • Symptoms
    • Lack of interest in surroundings, in self-care
    • Lack of energy, appetite
    • Altered sleep patterns
    • Suicidal ideation; physical complaints
  28. Mental Health Concerns in Older Clients: Depression, cont.
    • Pseudodementia
    • Condition in depressed clients
    • Client gives impression of being demented
    • Behaviors actually related to depression
  29. Mental Health Concerns in Older Clients: Depression, cont.
    • Factors that precipitate depression
    • Chemical imbalance; poor nutrition
    • Financial difficulties; poverty-level subsistence
    • Loss of spouse, friends, pet, roles
    • Chronic illness; debilitating disease
    • Lack of mental or physical exercise
    • Medication side effects
    • Drug or alcohol abuse
  30. Mental Health Concerns in Older Clients: Depression, cont.
    • Treatment
    • Goal of therapy: increasing client’s self-esteem
    • Involvement in social, recreational, cultural events
    • Participating in volunteer services, caring for pets: helpful and remotivating
    • Adequate exercise, balanced diet, antidepressant medications
    • Watch for suicide; take threats or gestures of suicide seriously
  31. Mental Health Concerns in Older Clients: Substance Abuse
    • Special problem in the older population
    • Contributing factors to geriatric chemical dependency
    • Loneliness
    • Depression
    • Older substance abuser
    • Often widow or widower, no longer has regular job
    • Alcoholism
    • Difficult to detect
  32. Mental Health Concerns in Older Clients: Substance Abuse, cont.
    • Many individuals
    • Little knowledge of medication interactions
    • See no harm in sharing medications with friends or spouse or in using medications after expiration date
    • May use chemicals as self-medication, taking larger doses than prescribed
    • May take duplicate prescriptions—some medications labeled in generic names whereas others use brand names
  33. Mental Health Concerns in Older Clients: Substance Abuse, cont.
    • Before treatment begins
    • Individual
    • Must accept help
    • Be prepared to change lifestyle patterns
  34. Measures for Emotional and Psychological Support
    • Evaluate confusion in older adults for
    • Organic pathologies
    • Substance abuse
    • Remotivation techniques
    • Important adjunct to therapy
    • Attempts to focus attention on the present
    • Calls on memories from the client’s past
  35. Measures for Emotional and Psychological Support, cont.
    • Recreation: in long-term care facility
    • Events designed to promote creativity
    • Goal: motivate seniors to use their physical and mental capabilities
    • Cognitive function
    • Older adults normally comprehend, appropriately use, understand language
    • Perform basic calculations; retain, recall information
    • Exercise of memory function
    • Helps maintain, improve short-term memory loss
  36. Special Concerns of the Aging Adult: Communication
    • Hearing and visual deficits
    • Cause difficulties in communication
    • Stroke, dementia
    • Alter language comprehension and use
    • Age barriers
    • Add to difficulties of engaging in social interaction
  37. Special Concerns of the Aging Adult: Communication, cont.
    • Avoid feelings of isolation and rejection
    • Regularly talk with others
    • Place older clients in double rooms: prevents isolation, provides more environmental stimulation
    • Encourage: participation in social events
    • Be aware of meanings of touch, body language
    • Make appropriate eye contact and show genuine interest when visiting
    • Listen attentively and sit down when speaking to demonstrate interest and respect
  38. Communication: Speech Impairment
    • Aphasia
    • Inability to use or understand speech
    • Mixture of deficits
    • Slow speech, incorrect speech
    • Use of incorrect words and sounds
    • Converse with client, even if client unable to speak
    • Encourage: communication—gestures, picture boards, diagrams, writing
  39. Key Concept
    Talk to the person, not about the person. Often, the person with aphasia has clear thinking processes.
  40. Safety
    • Accidents, especially falls
    • Increase with age
    • Leading cause of disability, death after age 65
    • Medications or age-related changes
    • Contribute to orthostatic hypotension
    • Lightheaded—may fall when getting out of bed or chair
    • Changes in visual acuity and depth perception disturb distance judging ability
  41. Safety, cont.
    • Safety check of home environment
    • Presence of risk factors for falls
    • Identify risks and plan measures to reduce them
  42. Safety: Loss of Proprioception
    • Proprioception
    • Awareness of posture, movement, and changes in equilibrium in relation to other objects
    • Many older people: unsure of where they are stepping
    • Teach clients
    • Be aware of obstacles and uneven ground
    • When walking: allow them to take your arm
    • Do not push or pull; avoid quick turns to prevent loss of balance
  43. Nursing Alert
    • Many older people are afraid of falling and may grab you or furniture when they are lifted or moved.
    • Never rush or frighten clients when assisting them.
  44. Safety Devices
    • Bathtubs and showers
    • Equipped with anti-slip surfaces, hand bars, and rails
    • Night lights for bathrooms and bedrooms
    • Use a cane, walker, or other assistive device
  45. Restraints (Client Safety Devices)
    • Devices placed on wrists and waist to restrict movement
    • Anything that limits client’s free movement
    • Chemical restraint
    • Medications to control behavior
    • Teaching to client and family
    • Purpose of restraint: keep the client safe
    • Interventions
    • Proper application
    • Frequent monitoring
    • Prevent injury
    • Ensure safety
    • Be aware: policies that affect nurses and their employers
    • Remind client: ask for assistance
    • Assure client: someone is available and willing to assist
  46. Restraints (Client Safety Devices), cont.
    • Client awake, aware, and cooperative but at risk of falling
    • Use a soft restraint
    • Raise side rail
    • Both side rails should not be up unless proper justification exists
    • Prevent falls
    • Keep beds in the lowest possible position
    • Encourage client to ask for assistance when getting out of bed
  47. Nursing Alert
    • In some situations, the client is in more danger with the side rails of the bed up.
    • A bed left in low position is safer than the client climbing over the side rails and falling.
  48. Physical Activity and Exercise
    • Exercise vital to
    • Maintain circulation, muscle tone, and general health
    • Prevent disuse deformities
    • Reduce loss of mineral from bones
    • Ambulatory person can
    • Walk, stretch, swim, do t’ai chi or yoga
    • Participate in competitive activities
  49. Physical Activity and Exercise, cont
    • Walking
    • Single most highly recommended exercise for older adults
    • Immobility a significant threat to older adults
    • Commonly associated with osteoporosis, kyphosis
    • Prevention
    • Appropriate diet
    • Increased calcium intake
    • Supplementary vitamin D
  50. Sexuality
    • Physical acts of affection, with or without intercourse
    • Important for individual’s physical, emotional well-being
    • Hugging, holding hands
    • Alleviate feelings of loneliness
    • Touch: therapeutic
    • Encourage clients to discuss with healthcare provider the impact of health conditions on sexual activity
  51. Elder Abuse
    • Includes
    • Emotional, physical, and sexual abuse
    • Financial exploitation
    • Neglect
    • Exploitation of older person
    • Sales gimmicks, medical quackery
    • Fear tactics
    • Con games
  52. Elder Abuse, cont.
    • Most common elder abusers
    • Adult children, relatives, spouses, service providers, friends or neighbors, grandchildren, siblings
    • Care of an older person
    • Exhaustion and frustration can be overwhelming—caregiver stress
  53. Elder Abuse, cont
    • Prevention of elder abuse
    • Recognition of
    • High-risk families and families with a recent disruption in lifestyle or living arrangements
    • Financial problems
    • Substance abuse
    • History of violence or mental illness
  54. Elder Abuse, cont.
    • When working with older clients
    • Address needs of caregivers as well as client
    • Caregivers need to know what resources are available
    • Respite from daily care can offer them relief