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Older Adults: Over 65 Years
- 2010- US pop= 308,935,581
- Approximately 40 million
- Projected to increase to 72 M by 2030
- 12.9% of the U.S. population in 2007
- 19.3% of US population by 2030
- Increasing minority pop.
- 4.1% or 1.60 million live in nursing homes
- States with most: CA, FL, NY, TX, PA, IL, OH, MI, NJ
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Attitudes toward aging
- Different cultures view elders differently
- Americans value youth
- Ageism is prejudice against older Americans
- Discrimination based solely on age
- Exists among some professionals
- Negative stereotypes based on myths and incorrect information
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Nursing and the Elderly
- Nurses will be caring for an older population
- Gerontology Nursing- specialized nursing practice, masters prepared RN, practice in a variety of settings
- Geriatrics- medical care of the elderly
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Settings for Elders
- Acute care facility- hospitals
- Long-term care facility (“resident”)
- “Nursing homes”
- Assisted living facility (ALF)
- -Immediate care
- -Skilled care
- -Alzheimer’s units
- Hospice - end stage of life care
- Rehabilitation
- Community- adult day care
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Normal Physiological Changes of Aging
- Skin –
- less elastic
- Dry
- fragile
- Neuromuscular-
- Brain – atrophies
- Reflexes – slowed while driving
- Mass declines
- Bones – lose minerals
- Sensory/Perception
- Sight
- Hearing
- Taste
- Lungs- lose elasticity
- Heart- thickens
- Arteries- stiffen
- Increase in BP
- GI-
- slow swallowing
- Slower digestion
- constipation
- GU
- Kidneys shrink
- Bladder changes
- Sex hormones decrease
- Sexual difficulties
- Immunity
- Decreased
- More prone to infections
- Endocrine
- Insulin resistance
- Metabolism
- Slower thyroid
- medicines & alcohol not processed as quickly
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Psychosocial Aging
- Retirement
- Economic change
- Grandparenting
- Relocation
- Home vs. ALF
- Maintaining Independence
- Maintaining self-esteem
- Facing Death & Grieving
- Women live longer
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Cognitive Abilities
- Perception
- Ability to interpret environment thro senses
- Cognitive ability
- Ability to think and problem solve same
- Effected by decreased blow flow to brain or disease
- Memory
- Long term- slower
- Short term- elders tend forget recent past
- Learning- need additional time for learning
- Motivation- need to see info as important
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Moral Reasoning & Spirituality
- Moral reasoning- several theories
- Values & beliefs due to experiences from living in a different era
- Cultural variations
- Spirituality
- Spirituality does not necessarily increase with age
- Elders today grew up when religion was important
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Health of the Elderly
- Disease is not a normal outcome of aging
- Certain problems do increase with age
- Chronic health problems
- Disabilities
- Healthy People 2010 focus areas for elderly
:- Access to care, health communication
- Diseases: arthrititis, cancer, diabetes
- Food safety
- Injury & violence pevention
- Immunizations
- Substance abuse & tobacco use
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Health Problems
- Injuries
- Chronic Illness
- Drug use & misuse
- Alcoholism
- Dementia- will discuss later
- Elder Mistreatment (Abuse)
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Injuries
- One of the Healthy People 2020 concerns
- Falls are major cause of fractures
- Driving injuries
- Fire hazards
- Hypothermia
- Medications - Polypharmacy
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Frail Elderly
- Defined as unplanned weight loss greater than 10 lbs in last year, weakness, poor endurance & energy, slowness & low activity level.
- The old-old age 85+ are at more risk
- Common health problems are mobility limitations, sensory impairment, cognitive decline, falls & increasing fraility
- Greater risk for malnutrition & dehydration
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Chronic Disabling Illness
- Heart disease, Cancer and Stroke leading cause of death & disability
- Chronic lower respiratory disease, pneumonia/influenza, Alzheimer’s, Diabetes, Nephritis, Accidents, Septicemia
- Hearing and visual diseases
- Cognitive dysfunctions
- Chronic diseases account for 70% of all deaths in U.S. which is 1.7 million each year
- Chronic illness brings about many lifestyle changes for the client and family.
- Affects client’s:
- Ability to perform ADL’s, IADL’s (Independent)
- Assistance with ambulation
- Inability to pay for health care needs
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Drug use & alcoholism
- Drug use & misuse
- Polypharmacy
- OTC
- Alcoholism
- The aging alcoholic
- The new alcoholic- late-onset, widowers
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Elder Abuse
- Can be physical, emotional or sexual
- Can involve neglect or economic exploitation
- Categories
- Domestic, takes place at home usually by family member or SO
- Institutional
- Self-neglect
- Individuals at most risk are those who are dependent because of immobility or altered mental status
- Victims may attempt to dismiss injuries as accidental and abusers may prevent victims from receiving proper medical care to avoid discovery
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Sensory Reception
Sensory Perception
- Sensory reception
- Process of receiving stimuli or data
- Sensory perception
- Conscious organization and translation of data into meaningful information
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Sensory Process
- 4 aspects must be present:
- Stimulus
- Receptor
- Impulse conduction
- Perception
To receive & interpret stimuli the person must be alert
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Factors Affecting Sensory Function
- Age/stage of life- elderly lose senses
- Culture- normal amount of stimulation varies
- Illness- MS, diabetes
- Medications- ASA & Lasix are ototoxic
- Stress- sensory overload
- Personality
- Lifestyle
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Sensory Alterations
- Sensory deprivation-
- Sensory overload
- Sensory deficits
- Impaired vision
- Impaired hearing
- Impaired taste
- Impaired smell
- Impaired tactile (touch) perception
- Impaired kinesthetic sense
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Nursing Process: Assessment
- Nursing history
- Mental status
- Physical exam
- Visual acuity
- Hearing- Rinne &Weber
- Smell
- Taste
- Tactile
- Client’s environment- sensory deprevation?
- Social support network- live alone, visitors
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Diagnosis
- Disturbed Sensory Perception (specify): Visual, auditory, kinesthetic, gustatory, tactile, olfactory
- Acute confusion
- Chronic confusion
- Impaired memory
- Risk for injury
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Planning/ Outcomes
- Preventing sensory overload or deprivation
- Maintain function of senses
- Reduce social isolation
- Perform ADLs independently & safely
- Preventing injury
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Sensory Deprivation
- Lack of meaningful stimuli
- Risk factors:
- Impaired sensory reception – pts with neurological injury, dementia, depression, sleep deprivation
- Cannot process stimuli – nerve or brain injury
- Have restricted mobility
- Confined to nonstimulating environment- homebound, healthcare facilities
- Sensory deficits – vision, hearing
- From different culture
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Clinical Manifestations of Sensory Deprivation
- Excessive yawning, drowsiness, and sleeping
- Decreased attention span, difficulty concentrating,
- Impaired memory
- Preoccupation with somatic complaints, such as palpitations
- Hallucinations or delusions
- Crying, annoyance over small matters and depression
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Implementation: Sensory deprivation
- Focus is prevention
- Support senses (e.g., glasses, hearing aids)
- Orientation
- •Calendar; view of environment
- Provide stimuli
- Regular contact; touch
- Television/radio
- •Pet therapy
- •Smells
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Sensory Overload
- Stimuli exceeds what the client’s sensory system can process
- Risk factors:
- Unfamiliar hospital environment
- Medications that stimulate CNS (prednizone)
- Caffeine
- Bronchodilators
- atropine
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Clinical Manifestations of Sensory Overload
- Irritability
- Confusion
- Reduced attention span
- Decreased problem-solving ability
- Drowsiness
- Complaints of fatigue and restlessness
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Sensory deficits: Vision Loss
- Presbyopia – loss of accomodation, associated with
- aging
- Cataracts- clouding of lens
- Glaucoma- increased pressure, loss of peripheral vision
- Macular Degeneration- loss of central vision
- Diabetic Retinopathy- hemorrhages in small vessels that supply retina
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Implementation: vision
- Orient client to environment
- Keep pathways clear
- Organize articles for easy reach
- Keep call bell close
- Assist with ambulation
- Keep glass local
- Provide sufficient light
- Magnifying glasses
- Big print books & materials
- Assess for need with help with ADLs
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Sensory deficit: Auditory (hearing) Loss
- Conduction
- – vibrations can’t be transmitted from outer to inner ear… cerumen, infections, punctured tympanic membrane, arthritis of auditory bones
- Nerve deafness- damage to cranial nerve VII…medications, infections, loud noise
- Central deafness- damage to auditory areas in temporal lobe…CVA (stroke), meningitis
- Presbycusis- hearing loss of high pitched tones assoc with aging..
- Tinnitus – ringing in ears…medications, HTN, arthritic changes of bones in ear
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Implementation: hearing
- Care of a hearing aid
- Closed-caption television
- Regular inspection of ear canals
- Techniques to improve communication
- Promote safety
- Assess for social isolation
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Sensory deficit: gustatory (taste)
- Xerostomia – excessively dry mouth
- Loss of ability to taste
- Interventions:
- Assess for sores or open areas in mouth
- Encourage seasonings & spices
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Sensory deficit: olfactory (smell) loss
- Anosmia – loss of sense of smell
- Home safety issues
- Interventions:
- Check gas appliances
- Check color, expiration dates on food
- Replace batteries smoke detectors
- Aromatherapy
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Sensory deficit: Tactile (touch) loss
- Touch, pressure, heat, cold, pain
- Hands & face have most receptors
- Interventions :
- Change position, proper fitting shoes & socks
- Careful with hot & cold applications
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Sensory deficit: Kinesthetic sense
- Proprioceptors detect stretch in muscles to create a picture how body is positioned
- Problems of inner ear impair kinesthesia
- Parkinsons, CVA, medications can impair
- Risk for balance & coordination problems & falls
- Interventions:
- Tai Chi, dancing, yoga, aerobic exercise, light weights
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Falls
- Account for 87% of all fractures among adults aged 65 years and older.
- Risk factors:
- Cognitive impairment
- Vision impairment
- Gait or balance impairments
- High risk medications
- Poor lighting
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The Confised Client: Delirium
- Common syndrome in hospitalized older adults
- Acute onset
- Temporary, may last hours to days
- Worsens at night
- Attention:
- Inattentive, easily distractible, has difficulty keeping track what is being said
- Causes:
- stress, sleep deprivation, polypharmacy, dehydration,
- infections, cerebral and cardiovascular disease
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The Confused Client:
Dementia (Alzheimer’s)
- Progressive loss of cognitive function
- Symptoms are progressive (7-15 years), slow, irreversible, poor outcome
- No change with time of day
- Changes in:
- Memory, judgment, language, mathematics, reasoning, and problem solving
- Often cared for at home, Strain on caretakers
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Interventions: Client with Delirium
- Reorient frequently
- •State your name; day, date, time
- •Provide clocks, calendars
- •Visual clues to time
- •Use personal belongings
- Maintain safe environment
- Communicate clearly, slowly
- •Respond to feelings
- •Use gestures
- Limit choices
- Promote feelings of security
- Use alternative therapies
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The Unconscious Client
- Coma is a deep state of unconsciousness that lasts for more than 2-4 weeks
- Be aware of sensory overload & deprivation
- Use techniques to stimulate the unconscious client
- Involves all 5 senses & kinesthetic
- Never speak about them at the bedside
- Speak to them as if they can hear you
- Continue orientation to reality
- Involve family members
- Incorporate more touch in plan of care
- May not blink- need eye care
- Safety measures:
- •Bed in low position
- •Side rails up
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