older adults one

65+

• Heart disease
• CA
• COPD
• Stroke
• Pneumonia

• osteoarthritis
• HTN
• joint problems

• delerium
• dementia
• vision
• hearing
• falls
• malnutrition
• incontinence
• depression
• sleep disorders
• functional limitations
• polypharmacy

delerium= alterations in consciousness, memory loss, rapid onset, cognition fluctuates during carious periods of the day

dementia= memory loss, language disturbance, alterations in motor activities, inabiulity to recognize familiar objects, gradual onset

• frailty
• functional decline
• geriatric syndromes

• follow std practice based on facility
• refrain from unnecessary interventions that may cause more harm than good

• wt loss of < 10 lbs. in one year or 5% of body wt
• weakness as measured by grip test
• self-reported poor stamina and exhaustion
• inability or difficulty walking 15 ft
• low physical activity level

• help ID patients who are frail
• want to do this before onset of the cycle of frailty
• **we really focus on functional assessments in older adults

the spiraling, unintended decline of health from a series of severe effects caused by medical intervention that have been used to solve previous symptoms or conditions

side effects of Tx cause a fast decline

• unable to walk w/o assistance
• low cognition
• highest in the oldest pt.s

• related sequence of 2 or more serious adverse events resulting from a diagnostic, prophylactic, or therapeutic intervention
• an error of omission involving a reasonable clinical std
• accidental injury occurs in hospital setting

• vague presentation of illness
• altered presentation of illness
• non-presentation of illness

atypical presentation of UTI

• > 85 yrs
• pt. w/ multiple comorbidies and meds
• pt. w/ cognitive or functional impairment

• change in ADL's, etc.
• Happens b/c of deconditioning

goal= live as independently as possible

• physical change of the body
• dec. ms mass and other changes that result from either aging or immobility or both, contribute to overall weakness

knowing this status PRIOR to admission can help predict a decline in ADL while admitted.

• steady= less likely
• unsteady= more likely

• dec. in ms strength and aerobic capacity
• vasomotor instability
• baroreceptor insensitivity
• reduced total body h@o
• altered thirst, taste, sell, and dentition
• reduced ventilation
• reduced sensation
• fragile skin

• in relation to decision making, remember to promote independence and autonomy in daily living
• pt.s are able to make their own decisions until proven otherwise

this does NOT change with age. Still 6-10

amount in deep sleep decreases with age

• alc= disruptor of REM due to sedative effect on CNS
• caf and nic= increase night time awakening and amount of time it takes to fall back asleep

old peeps should AVOID OTC sleep aids

stem cell #'s decline

***HOWEVER, this does not mean that Anemia is normal

Giving erythropoietin inc. bld cell production, causeing bone pain

• anemia
• DVT= watch for coag b/c platelets get stricky as we age
• cancer= inc. risk with age b/c # of carcinogen exposure

**common in old peeps BUT not normal

Dx may be neglected

• Low H&H may lead to:
• MI b/c of low O2
• falls
• confusion

transfusions

**Need to be very aware of vital signs during and afterr b/c pt. is subject to fluid overload and acute heart failure

# of cells in a liquid (as a %)

up to 4 hours, b/c that is the shelf life of the blood bag

• abnormalities in the vessel walls
• hypercoagulability
• stasis of bld flow

• get pt up and moving
• change position
• support stockings
• etc.

• clot busters
• heparin
• warfarin (coumadin)= clot prevention
• antiplatelets (ASA)

PT= prothrombin time= time required for clot to form after reagents have been added to bld

PTT= partial pt= time required to forma  clot after phospholipid reagents are added (for heparin)

• INR= international normalized rate= 1 is normal
• ***LOOK AT THIS FOR COUMADIN dosages b/c it will increase clot time

• prostate
• breast
• lung= leading cause

always keep comorbities in mind for cancer pt.s b/c they may be causing more trouble than the cancer itself

Cancer is the 4th most common comorbidity 

• 1. cardiovascular disease
• 2. cancer

detect geriatric syndromes

• Any 1 of these :
• > 85 yrs
• dependence in > 1 ADL's
• > 3 comorbid conditions
• presence of > 1 geriatric syndrome

• ADL
• IADL

ADL= basic activities needed to get the day going (bathing, dressing, grooming, eating, mobility, toileting)

IADL= activities needed to live Independently (paying bills, cleaning, laundry and meal preparation)

functional status

the more risk factors for frailty, the more likely to use palliative care b/c cancer treatment would be more detrimental than helpful

• 1. diet and exercise
• 2. screening such as mammograms
• 3. Tx for diagnosed pt.

• Is the person going to die OF or WITH cancer?
• Is the person at risk for the complications of cancer during his/her lifetime?
• Is the patient able to tolerate cancer treatment? (or is palliative care better?)

• ice chips
• avoid dehydration
• oral care solutions:
• saline, baking soda, or salt and soda solutions ONLY
• **No alcohol solutions

addiction is not to be feared when treating end of life pain

DNR Comfort Care=pt is given care that eases the pain, including meds if needed

DNR Comfort Care-Arrest=  pt receives standard care only until they die. 

feelings are not good or bad

the emotion felt after a loss

recovery period of time

• thickening of lens losses its elasticity
• most common visual problem

• increased intraocular pressure
• open angle is most common and fluid doesn't drain/circulate

hearing question is degenerative nerve anser

overall assessment tool

• useful for eliciting psychosocial context
• (mental state)

cross culture communication

cog duh