Assessment of the Older Adult

discrimination against people b/c of increasing age

the most common form of dementia characterized by brain atrophy and the development of senile plaques and neurofibrillary tangles in the cerebral hemispheres

• an acute confusional state
• an organic mental disorder characterized by confusion, disorientation, restlessness, fear and anxiety
• thought to be reverable

a mood disturbance characterized by feelings of sadness, despair and discouragement

• a generalized impairment of intellectual fx that interferes with social and occupational fx
• cognitive deterioration leads to a decline in ability to perform ADL's
• chronic, progressive cognitive decline with a slow onset
• unknown causes that is irreversible with a continuous duration.
• we treat the signs and symptoms bc there is nothing available to treat the condition itself
• NURSING INTERVENTIONS: reorientation in the early stages; validation therapy in the later stages; provvide a safe environment; observe for delusions, hallucinations and depression; diversion

• feelings of hopelessness
• a loss of hope

• the branch of medicine dealing with physiological and psychological aspects of aging
• the dx and tx of diseases affecting older adults

the assessment of the health and fx status of older adults as well as the dx and the implementation of the identified needs and the evaluation of there effectiveness

the study of all aspects of the aging process and its consequences

• Soundness
• Completeness

• a communication technique used to make the older adult more aware of time, place and person.
• the purpose is to restore a sense of reality, improve awareness, promote socialization, elevate independent fx and to minimize confusion and disorientation

• recalling the past
• a therapy that uses recollection of the past to bring meaning and understanding to the present and resolve current conflicts

the state of being old

a therapy which accepts the description of time and place as stated by the confused older adult, the statements of the confused are not confronted or reinforced

• Multiinfarct dementia
• dementia which results from interruptions in blood flow to the brain

• minority groups account for 15% of people over the age of 65
• estimated for the year 2030 suggest minorities will make up 25% of the older adult population
• the % of older African Americans is expected to increase from 7.9% to 11%
• most older adults live in non-institution settings;67% live in family settings; 32% live alone; 4% are in institutions such as nursing homes
• 90% of older adults have at least one chronic condition

• fixed income
• 85% of the older adults income is over the poverty level

• that they are ill, disabled or physically unattractive
• that they are not interested in sex or sexual activities
• that they are forgetful, confused, rigid, bored and unfriendly
• misconceptions abt financial status
• that they become worthless after they leave the workforce
• that their knowledge and experience is old fashioned with no current value

• adjusting to decreasing health and physical strength
• adjusting to retirement and reduced or fixed income
• adjusting to the death of a spouse
• accepting self as an aging person
• maintaining satisfactory living arrangements
• redefining relationship with adult children
• finding ways to maintain quality of life

• Erik Erikson says that as the human gets older they must come to terms with the aging process and the changes that associated with that and the feelings of life being over because of those changes.
• each individual will struggle with that as they become an older adult
• Erikson says that at any pt in life that are opposing forces and how well you deal with them will determine whether you grow or not
• are you able to accept the changes? yes, it will help you to become closer to the whole person; no; it will lower your self esteem and take away from the whole person that you can become

Japanese live longer than Americans by just a few years and it is believed that is due to diet

• heart disease
• cancer
• stroke
• lung disease
• accidents/falls
• kidney liver disease
• diabetes
• *all have preventative measures that could reduce the frequency of the disease and delay disability or death

• heart disease
• cancer
• stroke

• each RN's contact with an OA offers opportunity to teach and counsel
• directed towards improving or maintaining the OA needs and concerns
• health promotion, acute care and restorative care are used in planning
• attempt to make the OA u/s that early detection = early cure

• about risk factors associated with heart disease and stroke
• quit smoking/ drinking
• proper nutrition
• exercise
• proper medication use

acute or chronic confusion

• Immediate memory- occurs within the last 5-10 mins
• Recent memory- occurs within the last 24h
• Remote memory- occurs within years, possibly back to childhood

• Delirium- reversible acute confusion due to physiological causes. eg med side effects, metabolic disturbances, infection major loss or unexpected sxs
• Dementia- irreversible general impairment of intellectual fx that interferes with social or occupational fx. Alzheimer's DAT and Multi-infarct; s&s include loss of memory, poor judgement, changes in visio-spacial perception, changes in personality and physical deterioration.
• Depression- reduced happiness and well being; contributes to physical and social limitations, complicates tx and increases risk of suicide

• it is a transitional time for OA
• pre-retirement planning is imp to make a smoother transition
• OA should take an inventory of interests, current skills and general health
• OA also need to look at their financial plan as their income will differ

• discuss relationships with spouse and children
• discuss meaningful activities to replace the work role
• discuss adjusting or rebuilding social networks
• discuss issues related to income, health promotion and maintenance
• discuss long range planning such as wills and advanced directives

• Disengadgement theory- states that aging people withdraw from customary roles and engage in more introspective, self-focused activities rather than community activities
• Activity theory- states that the continuation of activities performed during the middle age is necessary for successful aging; when specific activities can not be continued they need to be replaced
• Continuity theory- states that personality remains the same and behavior becomes more predictable as people age; personality is a critical factor in determining the relationship bt role activity and life satisfaction

• Stochastic- aging is caused by random damage that accumulates over time; physiological changes of the aging process are due to the accumulation of various types of cellular damage
• Non-Stochastic- the occurrence of aging changes are predetermined by mechanisms in the body; physiological mechanisms control the process of aging

• Flatulance, constipation and fecal compaction occurs more often in the OA due to decreased peristalsis
• Decreased muscle tone in the perineal floor and anal sphincter can lead to incontinence
• Urinary incontinence can be caused by stool impaction, confusion, depression, medications, restricted mobility and UTI's
• Incontinence can result in embarrassment, rashes, infection,pressure sores, isolation and depression

• the kidneys fx normally but they are inable to tolerate insult or shock, ie. changes in blood volume
• the kidney weight and size decrease
• blood flow and excretion of toxins is decreased

• the penis loses subcutaneous fat and skin turgorthere is decreased
• testosterone production that can cause breast enlargement
• there is often enlargement of the prostate (hyperplasia)
• increased stimulation and decreased ability to attain an erection
• decreased need to ejaculate
• society attaches a negative stigma in reguard to the elderly and sex

• breast tissue is less resiliantand more pendulous
• decrease in the amount of pubic hair, clitoris size, muscle tone of the urethra and uterus size
• muscle atrophy in the vagina
• dryness of the mucosa causes a decrease in the vaginal lubrication

• walking 3-5x a week for 30 mins
• muscle mass decreases
• moderate exercise helps maintain an optimal level of fx; increase flexibility and balance; decreases the risk for heart disease.
• it may strengthen the immune system, reduce muscle pain, and promote relaxation

• bone demineralizes
• intervertebral space narrows, loss in height
• decrease in joint mobility
• increase in stiffness and pain because of osteoarthritis
• osteoporosis occurs when bone reabsorption exceeds born formation
• skin loses resiliance
• moisture lesions and keratosis appear
• facial features are more pronounced as skin loosens and subcutaneous fat fades
• respiratory muscle strength weakens

• Vision: less ability to adapt to light and dark; night vision is decreased;visual acquity is decreased; tear production is decreased
• Hearing: sound conduction is decreased and it becomes more difficult to discriminate between background noises

• falls
• MVA
• fires
• hyper/hypothermia bc they are more susceptible to temp changes

• generally decreased bc T-lymphocytes and antibody production is decreased
• response to infection is decreased
• increase in reoccurrence of dormant viruses. ie TB or Herpes Zoster

• Hygiene must be maintained in the OA bc they have poor skin integrity
• their skin is less elastic and more dry
• it bruises and tears easily
• it is slow to heal

• RR: ^increase 12-24
• Max HR: _decrease120
• O₂Sat: _decrease94%
• BP: ^increase 160/90

• OA lose lung elasticity so they cannot inflate and deflate completely
• coughing is difficult due to the weakened diaphragm and auxiliary muscles
• breathing is more difficult if kyphosis is present
• often they are "barrel chested" which is an increase in the AP diameter

• force of the myocardium contraction decreases
• cardiac output decreasesheart muscle decreases
• fatigue and SOB increase
• HR is slow to react to stress
• more time is needed to recover from tachycardia
• vascular resistance increases
• blood vessels become rigid
• circulation to the periphery slows and is recognized in cold hands and feet

• increased need for calcium, vit a and vit c
• decrease in calories due to the change in lifestyle
• require soft foods due to the lack of teeth
• require high fiber to avoid constipation

• require more fluids bc they are at a higher risk for dehydration and electrolyte balance
• might have to be limited due to diuretics, limited mobility and decreased bladder capacity

• there is a decrease in the sense of taste and smell
• they cant purchase food due to limited income, no transportation ot the inability to carry bags
• loneliness or depression
• physically or cognitively incapable of preparing food
• no place to store or prepare meals

• OA may get inadequate protein bc they cant chew meat; or there is too much fat in their diet
• OA tend to use to much salt and sugar to compensate for their diminished sense of taste
• vitamen intake decreases if they are not shopping for fruits and veggies

• home health care
• hospice
• day/respite/long term care
• housing shelter assistance
• seniors transport
• retirement/ assisted living facities
• church groups

• Life Review
• Remineiscence