AGING
Fa normal developmental process
Foccurring throughout the human life span
Fcauses a mild progressive decline in body system functioning
Folder client----- 65 years of age or older
BIOLOGIC THEORIES OF AGING
A. Immune system theory
1. 2 primary immune organs
-thymus
-bone marrow
Äaffected by the aging process
Äcontributes to a decline in T-cell production & stem cell efficiency
2. increase susceptibility to
Êinfection
Êautoimmune disease
Êcancer
B. Cross-linking theory
1. cross-linking
Äa chemical reaction that binds glucose to protein
Äwhich causes ---abnormal division of DNA
---interfering with normal cell functioning
---intracellular transport over a lifetime
2. tissue & organ failure
C. Free radical theory
1. molecules that are highly reactive
Äas a result of oxygen metabolism in the body
2. causes physical decline
Äby damaging proteins, enzymes & DNA
3. Beta-carotene & vitamins C & E
Änaturally occurring antioxidants
Êcounteract the free radicals
D. Stress theory [WEAR & TEAR]
1. the body------will eventually wear out
Äsecondary to repetitive usage, damage & stress
2. individuals react differently to stress
Êpositive
Ênegative
E. Genetics theory
1. preprogrammed life expectancy
Äcells can only divide a specific number of times
2. life expectancies among family members are the same
Fif parents died over the age of 80
Äthe children are more likely to live to that age
F. Neuroendocrine theories
1. anterior pituitary hormones
Äcontribute to the aging process
2. an imbalance of certain chemicals in the brain
Ämay contribute to altered cell division within the body
AGE-RELATED CHANGES
PSYCHOSOCIAL CHANGES IN THE OLDER ADULT
A. Successful aging process
FACTORS:
-physical
-psychological
-social
-cultural
1. some cultures have a great respect for older persons
2. in the US---much value is placed on the youth
3. be aware of ageism [discrimination against the older adult simply because of age]
Developmental tasks for the older adult
1. ego integrity vs. despair [Erikson]
a. with ego integrity
Äthe person’s life is felt to have meaning & Accomplishment
b. with despair
Äthere are feelings of worthlessness for a life not well Lived
2. other possible developmental tasks
a. successfully adjusting to retirement
b. making safe & satisfactory living arrangements
c. adjusting to reduced income
d. keeping socially active
e. maintaining contact with friends & family
f. making safe decisions about driving a car
g. adjusting to death of spouse/ significant other
h. adjusting to idea of one’s own death
PSYCHOLOGIC/SOCIAL THEORIES OF AGING
A. Activity theory
1. maintaining a level of active involvement in life
Ähelps the older adult stay psychologically & socially
Healthy
2. as life roles or physical capacity are lost
Äolder adult will substitute new roles or intellectual activities
B. Continuity or developmental theory
1. adjustment to old age is impacted by individual personality
Äolder adult will exhibit similar choices & decisions to
younger years
2. this theory allows for great variation in successful aging
Äas individual habits & preferences are unique
C. Disengagement theory
1. gradual mutual withdrawal between the individual & society
Äas the aging process continues
2. while this theory was a major milestone in aging research
Äit is now felt to be flawed
Äas many older adults remain engaged in psychosocial
aspects of life
PATTERNS OF HEALTH & DISEASE IN THE OLDER ADULT
A. Diseases that occur to varying degrees in most older adults
1. cataracts
2. arteriosclerosis
3. benign prostatic hypertrophy [males]
B. Diseases with increased incidence with advancing age
1. neoplastic disease
2. diabetes mellitus
3. dementia disorders
C. Diseases that have more serious consequences in the elderly & make homeostasis more difficult to maintain
1. pneumonia
2. influenza
3. trauma
D. Chronic disease very common
1. 79% of non-institutionalized persons are over age
70% have at least one chronic disease
2. most common chronic diseases:
-arthritis
-hypertension
-heart disease
3. most hospital visits for persons over 65 are for chronic diseases
E. Functional disability [inability to perform activities of daily living [ADL]]
1. 32% of persons over 65 years have some limitation of functions
2. 25% of persons over 65 require help with at least one ADL or IADL
Ä[instrumental activities of daily living
-e.g. shopping, paying bills
ASSESSMENT
Health History & Gerontologic Focus
A. assessment of the older adult client is complex
1. allow sufficient time to conduct a thorough health history Interview
2. depending on the client’s stability
Äthe interview may take more than one session
B. Presenting problem
1. assess client systematically depending upon the presenting Problem
2. typical presentations of disease may change with age
Äe.g. client may not exhibit chest pain with a myocardial
Infarction
3. the problem is likely to have multiple contributing factors & affect the client’s functional abilities
C. Mental status & mental health
1. it is important to obtain baseline for
-orientation
-memory
-level of alertness
-decision-making capabilities
2. assess the client for
-quality of life issues
-mood
-affect
-anxiety
D. Lifestyle & function
1. often, there is little correlation between diseases & functional Abilities
2. functional assessment provides clearer picture of physical, psychological & social health
3. use the client’s own baseline from previous assessments
Äto determine any changes in function
4. have the client demonstrate function wherever possible [e.g. observe gait & balance, drinking a glass of water, dressing self]
E. Medication usage
1. ask for information about all types of medications that the client is taking
-prescription medications
-nonprescription medications [analgesics & laxatives]
-vitamin supplements
-herbal medications
2. be sure the client understands the
-purpose
-dosage
-side effects
-special considerations or interactions for all medications
3. discuss the client’s abilities to obtain
medications
[e.g. renewing prescriptions, paying of medications]
4. polypharmacy is often present
Äaverage older adult takes 11 prescription medications per Day
F. Nutrition & hydration
1. obtain food / fluid intake profile [either 24 hours or 3 days]
2. determine any difficulties ingesting food / fluids [chewing,
salivation, swallowing, manual dexterity, tremors]
3. any foods the client is unable to eat [dairy products, sodium,
sugar]
or foods the client should eat [potassium- or calcium-rich
foods / fluids]
4. taking in adequate amounts of water daily to stay hydrated
5. ability to afford / purchase / prepare food
G. Past medical history
1. inquire about all chronic diseases & conditions
Äbe aware that the client may not even consider certain
conditions treatable & therefore does not mention them
-urinary incontinence
-or pain from arthritis
2. obtain information about
-previous illnesses
-hospitalizations
-surgeries
Physical Examination
A. assess body systems as indicated
B. note physical changes in the older adult
Laboratory / Diagnostic Tests
Laboratory tests as indicated according to symptoms of individual client
Interpret lab test results with aging changes in mind
ANALYSIS
Nursing diagnoses for older adult clients may include:
- activity intolerance
- bowel incontinence, constipation, diarrhea
- acute or chronic pain
- anxiety or death anxiety
- deficient fluid volume
- risk for infection
- impaired memory
- impaired physical mobility
- impaired oral mucous membrane
- imbalanced nutrition: less or more than body requirements
- ineffective airway clearance or breathing pattern or impaired gas exchange
- self-care deficits: feeding, bathing/hygiene, dressing/grooming, toileting
- disturbed body image or ineffective role performance
- disturbed sensory perception
- sexual dysfunction
- impaired skin integrity
- disturbed sleep pattern
- disturbed thought processes
- ineffective tissue perfusion
- impaired urinary elimination
- deficient diversional activity
- wandering
- impaired social interaction
- Risk for other – directed violence
- Risk for falls or injury
- Relocation stress syndrome
- Impaired home maintenance
PLANNING AND IMPLEMENTATION
Goals
Client will maintain:
Maximum functional independence
Normal bowel & bladder elimination patterns
Sufficient communication skills
Positive self-concept
Freedom from injury & infection
Optimal cognitive functioning
Adequate nutritional status & fluid balance
A restful sleep pattern
Social contacts & interpersonal needs
Treatment regimens as prescribed
INTERVENTIONS
Pharmacotherapy in the Older Adult
A. General information
1. decreased body weight
Dehydration
Alterations in fat to muscle ratio
Slowed organ functioning
Ämay cause accumulation of a drug in the body due to
higher concentrations in the tissues & slowed metabolism
& excretion of the drug
2. multiple chronic diseases affecting older adults
Ämay cause changes in the metabolism & excretion of Medications
3. medication errors among older community-dwelling adults are estimated to be 25-50%
4. drug-drug interactions are increased secondary to older adults often having more than one prescribing health care provider
B. Nursing Care
1. conduct a “brown bag” evaluation to assess all prescription,
Over-the counter, & herbal medications the client may be taking
2. assess the client’s understanding of the reasons for the drug therapy
3. assess the client’s vision, memory, judgment, reading level &
motivation to determine ability to self-medicate
4. provide instructions in large-print, pre-measured syringes,
memory aids & daily dose containers to enhance self-medicating abilities
5. check with the pharmacist for any drug-drug interactions if Unsure
6. before beginning a medication
Äobtain baseline vital signs
-mental status
-vision
-bowel / bladder function
7. drug-induced side effects may present as
-confusion
-incontinence
-falls
-immobility
8. assess the client’s ability to pay for the prescriptions
9. if the client requires assistance in taking medications
Äteach family members
Proper techniques for administering oral medications include
Fposition head forward
Fneck slightly flexed
Äto facilitate swallowing & avoid risk of aspiration
10. if client has swallowing difficulties
Äobtain liquid forms of oral medications wherever possible
11. assess client for effectiveness of medications & any adverse Reactions
EVALUATION
client performs self-care activities or caregiver provides assistance as needed
client is continent of bowel & bladder
Ävoids in adequate amounts & has regular bowel movements
client is able to successfully communicate needs & concerns
client makes positive statements about self
client/caregiver modifies environment to support safety
client is alert, calm, & oriented if possible
skin is intact without pressure ulcers
client eats a nutritionally balanced diet & maintains a stable weight
client maintains friends, social interactions & sexual function
client describes & adheres to treatment plan
Categories:
Nursing Management