welcome to geriatrics chapter 33 health promotion and care of the older adult

Welcome to Welcome to GeriatricsGeriatricsCHAPTER 33CHAPTER 33

Health Promotion and Care of the Health Promotion and Care of the Older AdultOlder Adult

Overview of Health and Overview of Health and WellnessWellness

Older adulthood- begins at about age 65 and Older adulthood- begins at about age 65 and continues until death, which covers a span of continues until death, which covers a span of about 40 years or more.about 40 years or more.

Young-old- ages 55 to 74 years.Young-old- ages 55 to 74 years. Old-old- 75 years and olderOld-old- 75 years and older Frail elder- over 75 years with health concerns.Frail elder- over 75 years with health concerns. Centenarians- older than 100 years of age.Centenarians- older than 100 years of age.

Chapter 33 GeriatricsChapter 33 Geriatrics

Chronological age is the amount of time Chronological age is the amount of time that has elapsed since birth.that has elapsed since birth.

Chronological age is a poor indicator of Chronological age is a poor indicator of old age.old age.

Some individuals are “ old” in their 50’s Some individuals are “ old” in their 50’s and others in their 90’s are physically and and others in their 90’s are physically and mentally active.mentally active.


Demographics: Demographics: In the U.S. in 1990, over 12% of the population In the U.S. in 1990, over 12% of the population

was 65 years and older.was 65 years and older. During the past 2 decades, the older adult During the past 2 decades, the older adult

population has grown twice as fast as the rest population has grown twice as fast as the rest of the population.of the population.

It is projected by the year 2030, over 21% of It is projected by the year 2030, over 21% of the population will be older than 65 years of the population will be older than 65 years of age.age.


The majority will be women at about 60% The majority will be women at about 60% and the men will be at 40%.and the men will be at 40%.

Majority will be white at 90.5% and Majority will be white at 90.5% and African Americans and other races make African Americans and other races make up 9.5% of older adults.up 9.5% of older adults.

Health care system has become more Health care system has become more complex for several reasons.complex for several reasons.


Demographics continued:Demographics continued: Scientific advances more often delay life-Scientific advances more often delay life-

threatening conditions of the past.threatening conditions of the past. Life expectancy has substantially Life expectancy has substantially

increased.increased. More focus has been placed on ethical More focus has been placed on ethical

and legal issues related to life, disease, and legal issues related to life, disease, research, and dying.research, and dying.

Chapter 33 Geriatrics.Chapter 33 Geriatrics.

Wellness, Health Promotion, and Wellness, Health Promotion, and Disease Prevention.Disease Prevention.

An emergence of the holistic movement An emergence of the holistic movement is changing the perception of health from is changing the perception of health from the absence of disease to a broader the absence of disease to a broader definition of wellness.definition of wellness.

Wellness is based on a belief that each Wellness is based on a belief that each person is has an optimal level of function.person is has an optimal level of function.


Even people that have a chronic illness and Even people that have a chronic illness and dying deserve some level of well-being.dying deserve some level of well-being.

There are numerous myths and stereotypes of There are numerous myths and stereotypes of aging.aging.

Box 33- 3 talks about some of the myths of Box 33- 3 talks about some of the myths of aging.aging.

Research has proven myths to be inaccurate.Research has proven myths to be inaccurate.


Theories of aging:Theories of aging: Current knowledge about aging and aging Current knowledge about aging and aging

process is very limited.process is very limited. Biological theories attempt to explain why Biological theories attempt to explain why

the body ages.the body ages. Psychosocial theories give reasons for the Psychosocial theories give reasons for the

response and interactions older adults response and interactions older adults have with society during adulthood.have with society during adulthood.


Social Security Act of 1935 was the first major Social Security Act of 1935 was the first major legislation that attempted to provide financial legislation that attempted to provide financial security for older adults.security for older adults.

Older Americans Act- objective was to Older Americans Act- objective was to preserve the right and dignity of our nations preserve the right and dignity of our nations older citizens.older citizens.

National Family Caregiver Support program- National Family Caregiver Support program- provided a way to address the growing needs provided a way to address the growing needs of caregivers.of caregivers.


Caregivers face often experience role Caregivers face often experience role overload.overload.

May not be enough time to meet the May not be enough time to meet the demands for caring for a family member.demands for caring for a family member.

Caregivers are at increased risk for Caregivers are at increased risk for stress related problems such as stress related problems such as depression, anxiety, and increased depression, anxiety, and increased vulnerability to health problems.vulnerability to health problems.


Important to assess the coping of Important to assess the coping of caregiver and person being cared for.caregiver and person being cared for.

Conflict arises when family members Conflict arises when family members when one family member lives close to when one family member lives close to the older person and one lives far away.the older person and one lives far away.

May need to remind distant family May need to remind distant family members to remain objective about what members to remain objective about what they see and what the older adult says.they see and what the older adult says.


Loss, grief and Depression:Loss, grief and Depression: Changes in roles of parents, siblings, Changes in roles of parents, siblings,

children, spouses and friends.children, spouses and friends. Physical changes result in loss of Physical changes result in loss of

independence and space.independence and space. May occur suddenly or gradually,May occur suddenly or gradually, Takes time for coping and grieving and Takes time for coping and grieving and

depends on many factors.depends on many factors.


Stress related to personal loss may either Stress related to personal loss may either be short-term or long-term.be short-term or long-term.

Fatigue, sadness, insomnia, anorexia, Fatigue, sadness, insomnia, anorexia, helplessness, crying, agitation, and helplessness, crying, agitation, and hypochondria are frequent symptoms of hypochondria are frequent symptoms of depression in older adults.depression in older adults.

May be misunderstood as changes that May be misunderstood as changes that naturally occur with aging.naturally occur with aging.


End of life care:End of life care: Nurse is responsible for helping the Nurse is responsible for helping the

entire health care team meet the needs entire health care team meet the needs of dying patients.of dying patients.

This includes caring for families.This includes caring for families. Knowledge of a patients culture and Knowledge of a patients culture and

religion help the nurse provide religion help the nurse provide compassionate care.compassionate care.


The aging body:The aging body: Numerous changes occur in all body Numerous changes occur in all body

systems during the aging process.systems during the aging process. Disuse caused by inactivity is probably Disuse caused by inactivity is probably

the most important contributor to the most important contributor to declining physical mobility and function.declining physical mobility and function.

Positive lifestyle changes include Positive lifestyle changes include physical activity and proper nutritionphysical activity and proper nutrition


Integumentary system: Age related Integumentary system: Age related changes.changes.

Lack of pigment in hair ( graying )Lack of pigment in hair ( graying )

Thinning hair and baldness.Thinning hair and baldness.

Less collagen and elasticity in the skin, with Less collagen and elasticity in the skin, with less fat under the skin ( wrinkles ).less fat under the skin ( wrinkles ).

Thinning of the epidermis and reduced Thinning of the epidermis and reduced number of oil and sweat glands.number of oil and sweat glands.


Integumentary system cont:Integumentary system cont: Age spots ( lentigo ). Tan or brown spots Age spots ( lentigo ). Tan or brown spots

caused by sun exposure.caused by sun exposure. Thinning of the epidermis and reduced Thinning of the epidermis and reduced

number of oil and sweat glands.number of oil and sweat glands. Increased fragility of blood vessels, Increased fragility of blood vessels,

resulting in ecchymosis.resulting in ecchymosis.


Assessment of Integumentary system:Assessment of Integumentary system: Observe skin for signs of excessive Observe skin for signs of excessive

dryness or openings in the skin.dryness or openings in the skin. Observe hair for excessive loss, dryness, Observe hair for excessive loss, dryness,

or oiliness.or oiliness. Observe nails for excessive length, sharp Observe nails for excessive length, sharp

edges, brittleness, increased thickening, edges, brittleness, increased thickening, and yellowing.and yellowing.


Integumentary cont:Integumentary cont: Pruritus- dryness and itching especially in Pruritus- dryness and itching especially in

cold weather.cold weather. Caused by reduced glandular secretions Caused by reduced glandular secretions

and moisture.and moisture. Soaps may cause drying.Soaps may cause drying. Need to use sparingly and rinse skin Need to use sparingly and rinse skin

thoroughly.thoroughly.


Integumentary system cont:Integumentary system cont: Pressure ulcers: occur when there is Pressure ulcers: occur when there is

sufficient pressure on the skin to cause sufficient pressure on the skin to cause the blood vessels in that area to collapse.the blood vessels in that area to collapse.

Thin skin and lack of subcutaneous fat Thin skin and lack of subcutaneous fat predispose older adults to pressure predispose older adults to pressure ulcers when fragile skin is compressed ulcers when fragile skin is compressed between bony prominences.between bony prominences.


Shearing forces may produce injury by Shearing forces may produce injury by sliding on a rough surface.sliding on a rough surface.

Pressure points are best prevented by Pressure points are best prevented by turning at least every 2 hours.turning at least every 2 hours.

Important to use aids that minimize Important to use aids that minimize pressure without restricting circulation.pressure without restricting circulation.

Friction from rubbing thin skin against Friction from rubbing thin skin against bed sheets is most common.bed sheets is most common.


Integumentary cont:Integumentary cont: Urine, drainage, or fecal matter left on skin for Urine, drainage, or fecal matter left on skin for

any amount of time may cause skin any amount of time may cause skin breakdown.breakdown.

Prevention is the best measure for pressure Prevention is the best measure for pressure ulcers.ulcers.

Well balanced diet with special attention to Well balanced diet with special attention to protein, vitamins, and minerals is essential.protein, vitamins, and minerals is essential.


Gastrointestinal system:Gastrointestinal system: Age related changes:Age related changes: Decreased secretion of saliva and Decreased secretion of saliva and

enzymes in the intestinal tract.enzymes in the intestinal tract. Atrophy and decreased tone of the Atrophy and decreased tone of the

intestine.intestine. Decreased peristalsisDecreased peristalsis


Gastrointestinal cont:Gastrointestinal cont: Changes may be intensified by medications, Changes may be intensified by medications,

lack of dietary fiber or roughage, and lack of lack of dietary fiber or roughage, and lack of exercise.exercise.

Nutritional problems account for about one Nutritional problems account for about one third to one half of health problems in the older third to one half of health problems in the older adult.adult.

Assessment and intervention promotes a better Assessment and intervention promotes a better quality of life.quality of life.


Gastrointestinal cont:Gastrointestinal cont: Assessment:Assessment: Assess oral cavity for lesions, dental Assess oral cavity for lesions, dental

caries, loose teeth, and halitosis.caries, loose teeth, and halitosis. Assess ability to chew and swallow.Assess ability to chew and swallow. Assess for complaints of intestinal Assess for complaints of intestinal

cramping.cramping. Assess dietary intake and weight.Assess dietary intake and weight.


Gastrointestinal cont:Gastrointestinal cont: Assess for signs of abdominal distention.Assess for signs of abdominal distention. Assess bowel elimination and use of Assess bowel elimination and use of

laxatives.laxatives. Assess individual’s ability to control Assess individual’s ability to control

defecation.defecation. Assess bowel elimination routes.Assess bowel elimination routes.


Common concerns and nursing interventions:Common concerns and nursing interventions: Obesity- defined as weight 20% above ideal Obesity- defined as weight 20% above ideal

body weight.body weight. Older adults need less calories than they did Older adults need less calories than they did

when they were younger and more active.when they were younger and more active. Gradual weight loss is normal, rapid weight Gradual weight loss is normal, rapid weight

loss may indicate illness.loss may indicate illness.


Fluids and hydration status:Fluids and hydration status: Fluids should be available and toileting Fluids should be available and toileting

facilities easily accessible.facilities easily accessible. Arrange room so that access to the bathroom Arrange room so that access to the bathroom

is not obstructed.is not obstructed. Older adult may need to be assisted to the Older adult may need to be assisted to the

bathroom as often as every 2 hours.bathroom as often as every 2 hours. If elder is disoriented they may need If elder is disoriented they may need

prompting.prompting.


Oral hygiene- thorough cleansing of the Oral hygiene- thorough cleansing of the mouth should be done with a soft-bristled mouth should be done with a soft-bristled toothbrush in the morning and at bedtime.toothbrush in the morning and at bedtime.

Missing teeth and poor fitting dentures Missing teeth and poor fitting dentures may make chewing difficult.may make chewing difficult.

Loss of appetite- prepare food using color Loss of appetite- prepare food using color and garnishes, attractive dishes, and set and garnishes, attractive dishes, and set table with good light and bright colors.table with good light and bright colors.


Older adults may not want to eat alone.Older adults may not want to eat alone. If they are grieving the loss of a spouse If they are grieving the loss of a spouse

or are unable to leave their home they or are unable to leave their home they may experience hopelessness, grieving, may experience hopelessness, grieving, and social isolation.and social isolation.

Meals on Wheels and community meal Meals on Wheels and community meal programs may be helpful to assist in programs may be helpful to assist in proper nutrition.proper nutrition.


Gastric reflux occurs when the sphincter Gastric reflux occurs when the sphincter at the opening to the stomach becomes at the opening to the stomach becomes less efficient allowing food and digestive less efficient allowing food and digestive enzymes to flow back into the enzymes to flow back into the esophagus.esophagus.

Symptoms include heartburn, sour Symptoms include heartburn, sour stomach, and regurgitation of sour stomach, and regurgitation of sour material.material.


Treat reflux by encouraging small frequent Treat reflux by encouraging small frequent meals, not eating before bedtime, and meals, not eating before bedtime, and elevation of the head of the bed.elevation of the head of the bed.

Lactose intolerance is common in the older Lactose intolerance is common in the older adult may need to replace milk with cheese or adult may need to replace milk with cheese or yogurt.yogurt.

Dysphagia- difficulty swallowing. Can be Dysphagia- difficulty swallowing. Can be caused by trauma, stroke, or obstruction from a caused by trauma, stroke, or obstruction from a tumor.tumor.


Assess ability to swallow liquids and solids.Assess ability to swallow liquids and solids. Intervention for difficulty swallowing include Intervention for difficulty swallowing include

avoiding liquids, thickening liquids, positioning avoiding liquids, thickening liquids, positioning and verbal coaching if necessary.and verbal coaching if necessary.

Reducing distractions in the room and cueing Reducing distractions in the room and cueing patient to swallow facilitate success.patient to swallow facilitate success.


Constipation:Constipation: An abnormal or difficult passage of hard, dry, An abnormal or difficult passage of hard, dry,

feces.feces. May result in fecal impaction.May result in fecal impaction. Constipation can be acute or chronic.Constipation can be acute or chronic. Assess dietary intake of fluids, fiber, Assess dietary intake of fluids, fiber,

medications, overuse of laxatives, exercise medications, overuse of laxatives, exercise patterns, and inability to reach the toilet.patterns, and inability to reach the toilet.


Urinary system:Urinary system: Overall kidney function and bladder capacity Overall kidney function and bladder capacity

decrease with age.decrease with age. Bladder may hold only 150 ml.Bladder may hold only 150 ml. The bladder and sphincters lose elasticity and The bladder and sphincters lose elasticity and

are less responsive to the stimulus to urinate.are less responsive to the stimulus to urinate. Decrease in bladder tone may cause urine to Decrease in bladder tone may cause urine to

remain in bladder after voiding.remain in bladder after voiding.


Urinary cont:Urinary cont: Men commonly experience enlargement of the Men commonly experience enlargement of the

prostate.prostate. Assess for frequency, amount, color, odor and Assess for frequency, amount, color, odor and

consistency of urine output.consistency of urine output. Assess the individuals ability to control Assess the individuals ability to control

urination.urination. Aging may cause changes with sexual Aging may cause changes with sexual

intercourse.intercourse.


Urinary cont:Urinary cont: Nocturia is known as excessive urination Nocturia is known as excessive urination

at night. Usually two or more times during at night. Usually two or more times during the night.the night.

Interventions focus on limiting fluids at Interventions focus on limiting fluids at hs, taking medications such as diuretics hs, taking medications such as diuretics in am.in am.

Fatigue may cause an increase in falls.Fatigue may cause an increase in falls.


Urinary:Urinary: UTI may trigger incontinence. Need to UTI may trigger incontinence. Need to

seek treatment.seek treatment. Stress incontinence-leaking of urine Stress incontinence-leaking of urine

when a person strains such as sneezing, when a person strains such as sneezing, coughing, laughing, dancing, etc.coughing, laughing, dancing, etc.

Treatment includes Kegel exercises, Treatment includes Kegel exercises, bladder retraining.bladder retraining.


Urge incontinence- urgency before voiding Urge incontinence- urgency before voiding caused by bladder spasms. Involuntary caused by bladder spasms. Involuntary loss of urine follows a sudden desire to loss of urine follows a sudden desire to urinate. Usually cannot stop once they urinate. Usually cannot stop once they start urinating. May be caused by infection start urinating. May be caused by infection or very concentrated urine. Treatment or very concentrated urine. Treatment includes bladder retraining, increase in includes bladder retraining, increase in fluid intake to dilute urine or treatment of fluid intake to dilute urine or treatment of infection.infection.


Overflow incontinence- bladder is full and Overflow incontinence- bladder is full and does not empty completely. Urine leaks does not empty completely. Urine leaks or dribbles out.or dribbles out.

May be caused by a enlarged prostate or May be caused by a enlarged prostate or bladder weakness.bladder weakness.

Treatment includes relief of obstruction, Treatment includes relief of obstruction, medication, or bladder retraining.medication, or bladder retraining.


Functional incontinence- inability or Functional incontinence- inability or unwillingness to urinate. May result from unwillingness to urinate. May result from depression, confinement to bed, restraints, depression, confinement to bed, restraints, physical limitations.physical limitations.

Nursing should understand that the patient is Nursing should understand that the patient is not trying to get attention. Never reprimand or not trying to get attention. Never reprimand or humiliate patient. May need to treat with humiliate patient. May need to treat with surgery, medications, pelvic exercises. May surgery, medications, pelvic exercises. May need briefs or panty liners.need briefs or panty liners.


Cardiovascular System:Cardiovascular System: Changes involve loss of structural Changes involve loss of structural

elasticity. Takes longer for the heart elasticity. Takes longer for the heart chambers to fill.chambers to fill.

Heart valves become thicker and more Heart valves become thicker and more rigid. There is a decrease in the number rigid. There is a decrease in the number of pacemaker cells and electrical of pacemaker cells and electrical conductions is slowed.conductions is slowed.


Cardiovascular:Cardiovascular: Resting heart rate may decrease.Resting heart rate may decrease. Atherosclerosis develops, which increases Atherosclerosis develops, which increases

blood pressure.blood pressure. Decreased elasticity of blood vessels also Decreased elasticity of blood vessels also

contribute to hypertension.contribute to hypertension. Hypertension is defined as a blood Hypertension is defined as a blood

pressure greater than 140/90 systolic.pressure greater than 140/90 systolic.


Cardiovascular disease is the leading Cardiovascular disease is the leading cause of disease in the U.S.cause of disease in the U.S.

Patient may have orthopnea or difficulty Patient may have orthopnea or difficulty breathing.breathing.

Examine for chest pain. May not exhibit the Examine for chest pain. May not exhibit the usual signs and symptoms. May usual signs and symptoms. May complain of nausea only or indigestion.complain of nausea only or indigestion.


Cardiovascular:Cardiovascular: May have dysrhythmia- irregular heart beat May have dysrhythmia- irregular heart beat

rhythms.rhythms. Older adult may experience claudication a Older adult may experience claudication a

cramping in the calves. Relieved by rest.cramping in the calves. Relieved by rest. Monitor patients activity level and provide Monitor patients activity level and provide

rest periods before and after activities.rest periods before and after activities. Monitor vital signs frequentlyMonitor vital signs frequently


American Heart Association recommends American Heart Association recommends 30 minutes of moderate intense exercise 30 minutes of moderate intense exercise four to five times a week.four to five times a week.

Older adults should begin with a 10-15 Older adults should begin with a 10-15 minute warm-up. Walking is the best minute warm-up. Walking is the best aerobic exercise for older adults.aerobic exercise for older adults.

They can choose the location and They can choose the location and exercise at their own pace.exercise at their own pace.


Respiratory System;Respiratory System; Tissue of lungs and bronchi become less Tissue of lungs and bronchi become less

elastic and more rigid with age. Causes a elastic and more rigid with age. Causes a decrease in vital capacity.decrease in vital capacity.

Chest wall is less able to expand because Chest wall is less able to expand because of changes in the skeletal system. Ribs of changes in the skeletal system. Ribs become less mobile, cartilage calcifies, become less mobile, cartilage calcifies, and osteoporosis may take place.and osteoporosis may take place.


Respiratory:Respiratory: Muscles associated with respiration are Muscles associated with respiration are

weakened, so that lung expansion is weakened, so that lung expansion is decreased.decreased.

Overall the older person’s air exchange is Overall the older person’s air exchange is reduced, and secretions remain in the lungs. reduced, and secretions remain in the lungs. Causes a risk for pneumonia.Causes a risk for pneumonia.

May become short of breath with any exertion.May become short of breath with any exertion.


Respiratory :Respiratory : Lessened cough mechanism leads to risk Lessened cough mechanism leads to risk

of infection.of infection. Alveoli thicken and decrease in number Alveoli thicken and decrease in number

leading to a less effective gas exchange.leading to a less effective gas exchange. Skeletal structure changes ( kyphosis) Skeletal structure changes ( kyphosis)

can decrease diaphragmatic expansion.can decrease diaphragmatic expansion.


Common respiratory disorders:Common respiratory disorders: COPD- Chronic Obstructive Pulmonary COPD- Chronic Obstructive Pulmonary

Disease is a combination of chronic bronchitis, Disease is a combination of chronic bronchitis, asthma, and emphysema. Smoking greatly asthma, and emphysema. Smoking greatly increases the risk. By the age of 90 years of increases the risk. By the age of 90 years of age almost everyone has some degree of age almost everyone has some degree of COPD.COPD.

Treatment includes adequate fluid intake, avoid Treatment includes adequate fluid intake, avoid smoking, avoid crowds, avoid people with smoking, avoid crowds, avoid people with respiratory infections, and encourage flu respiratory infections, and encourage flu vaccines annually.vaccines annually.


Pneumonia- inflammation of the alveoli, tissue, Pneumonia- inflammation of the alveoli, tissue, and bronchioles of the lungs.and bronchioles of the lungs.

Can be life threatening for older adults.Can be life threatening for older adults.Exercise will help however patient may only be Exercise will help however patient may only be

able to exercise very small amounts at first. able to exercise very small amounts at first. May need small frequent meals.May need small frequent meals.

Adequate fluid intake will liquefy secretions.Adequate fluid intake will liquefy secretions.Important to teach coughing to clear airway Important to teach coughing to clear airway

secretions.secretions.


Respiratory:Respiratory: Promote turning, coughing, and deep Promote turning, coughing, and deep

breathing to improve gas exchange.breathing to improve gas exchange. May have dyspnea on exertion or stress.May have dyspnea on exertion or stress. Assist with the removal of secretions for Assist with the removal of secretions for

a patient that is unable to cough or expel a patient that is unable to cough or expel secretions.secretions.


Musculoskeletal System:Musculoskeletal System: Reduction takes place in the number and Reduction takes place in the number and

size of muscle fibers with decreased size of muscle fibers with decreased muscle strength.muscle strength.

Joints become less elastic and flexible Joints become less elastic and flexible with the loss and calcification of cartilage.with the loss and calcification of cartilage.

Bones demineralization leads to Bones demineralization leads to osteoporosis.osteoporosis.


Musculoskeletal System:Musculoskeletal System: Change in the structure of the bones in the Change in the structure of the bones in the

spine and compression of intravertebral discs spine and compression of intravertebral discs result in postural changes such as kyphosis.result in postural changes such as kyphosis.

Kyphosis- an abnormal curve in the upper Kyphosis- an abnormal curve in the upper spine also called dowagers hump.spine also called dowagers hump.

Kyphosis can alter respirations and air Kyphosis can alter respirations and air exchange.exchange.


Musculoskeletal cont:Musculoskeletal cont: Post menopausal women have a Post menopausal women have a

decrease in estrogen causing more bone decrease in estrogen causing more bone resorption and a decrease in calcium.resorption and a decrease in calcium.

May interfere with person’s ADL such as May interfere with person’s ADL such as eating, bathing, grooming, driving, etc.eating, bathing, grooming, driving, etc.

Women especially need adequate Women especially need adequate calcium intake as well as Vitamin D.calcium intake as well as Vitamin D.


Musculoskeletal cont:Musculoskeletal cont: Arthritis- inflammation of a joint usually 0.Arthritis- inflammation of a joint usually 0. accompanied by pain and swelling.accompanied by pain and swelling. Rheumatoid arthritis- a systemic inflammatory Rheumatoid arthritis- a systemic inflammatory

disease most common in women after age 60.disease most common in women after age 60. Osteoarthritis- a degenerative joint disease. Osteoarthritis- a degenerative joint disease.

Cartilage of joint deteriorates and new bone Cartilage of joint deteriorates and new bone forms on surface.forms on surface.


Treatment for arthritis:Treatment for arthritis: Relief stress on joints by resting and using Relief stress on joints by resting and using

assistive devices such as splints and assistive devices such as splints and walkers.walkers.

Range of motion exercises and other Range of motion exercises and other forms of mild exercise.forms of mild exercise.

Heat and gentle massage.Heat and gentle massage. Warm showers, NSAIDS.Warm showers, NSAIDS.


Falls are a common concern for the Falls are a common concern for the elderly.elderly.

Hip fractures are the most frequently Hip fractures are the most frequently occurring for older adults.occurring for older adults.

Nursing interventions include:Nursing interventions include: An environment free of hazards.An environment free of hazards. Increase lighting for decreased vision.Increase lighting for decreased vision. Provide assistive devices.Provide assistive devices.


Nursing Interventions cont:Nursing Interventions cont: Teach patient to sit on the side of the bed Teach patient to sit on the side of the bed

when arising and to stand for several minutes when arising and to stand for several minutes before walking.before walking.

Encourage exercise to increase strength, Encourage exercise to increase strength, balance, endurance, and body awareness.balance, endurance, and body awareness.

Osteoporosis is a systemic skeletal disease Osteoporosis is a systemic skeletal disease with low bone mass and deterioration of bone with low bone mass and deterioration of bone tissue.tissue.


Osteoporosis of the spine may cause a loss of Osteoporosis of the spine may cause a loss of height as much as 1 to 2 ½ inches.height as much as 1 to 2 ½ inches.

Prevent with a diet high in calcium and Vitamin Prevent with a diet high in calcium and Vitamin D. Women need 1000 to 1500 mg of calcium D. Women need 1000 to 1500 mg of calcium daily.daily.

Regular weight bearing exercises are also Regular weight bearing exercises are also needed.needed.

Hormone replacement therapy as well as Hormone replacement therapy as well as calcium supplements may be needed.calcium supplements may be needed.


Endocrine system:Endocrine system: Level of hormones released are altered.Level of hormones released are altered. High blood sugar may occur because of High blood sugar may occur because of

slowed insulin release.slowed insulin release. Thyroid changes may occur such as Thyroid changes may occur such as

hypothyroidism. Patient will have weight hypothyroidism. Patient will have weight gain, dry skin, thinning of hair, gain, dry skin, thinning of hair, intolerance to cold, and depression.intolerance to cold, and depression.


Reproductive System:Reproductive System: Male and females have a diminished level of Male and females have a diminished level of

hormones.hormones. Sexual function diminishes but does not Sexual function diminishes but does not

disappear.disappear. Menopause decreases vaginal secretions Menopause decreases vaginal secretions

causing dryness.causing dryness. Greatest obstacle is the lack of sexual Greatest obstacle is the lack of sexual

discussion by the nurse.discussion by the nurse.


Vision:Vision: Cataracts are the most common disorder found Cataracts are the most common disorder found

in the aging eye. A cataract is a clouding of the in the aging eye. A cataract is a clouding of the normally clear eye. The size and location normally clear eye. The size and location determine the amount of light interference. determine the amount of light interference.

Patient will have cloudy vision, sensitivity to Patient will have cloudy vision, sensitivity to glare, and will need a brighter light to read.glare, and will need a brighter light to read.


PresbyopiaPresbyopia May have narrowing of the peripheral May have narrowing of the peripheral

vision.vision. Decreased ability to focus on near Decreased ability to focus on near

objects.objects. Depth perception is distorted and vision Depth perception is distorted and vision

in dim light is difficult.in dim light is difficult.


Hearing impairment:Hearing impairment: Presbycussis- cannot hear high pitched Presbycussis- cannot hear high pitched

tones and conversational speech.tones and conversational speech. One third of older Americans have hearing One third of older Americans have hearing

loss. Exposure to a variety of loud noises loss. Exposure to a variety of loud noises through out life contributes to hearing loss.through out life contributes to hearing loss.

Cerumen impaction is an often overlooked Cerumen impaction is an often overlooked cause of hearing loss.cause of hearing loss.


Touch:Touch: Decreased number of receptor cells in the skin Decreased number of receptor cells in the skin

and joints.and joints. Older adults will have difficulty sensing Older adults will have difficulty sensing

temperature and maintaining balance. temperature and maintaining balance. Increases the risk of falls and burns.Increases the risk of falls and burns.

Make sure patients eyeglasses are clean and Make sure patients eyeglasses are clean and are available. Increase the amount of light if are available. Increase the amount of light if needed. Use night lights for bedtime.needed. Use night lights for bedtime.


Treatment for decreased hearing:Treatment for decreased hearing: Hearing aids if needed.Hearing aids if needed. Face the individual and speak at a Face the individual and speak at a

normal or slightly slower pace. Do not normal or slightly slower pace. Do not speak loudly because hearing is loss is speak loudly because hearing is loss is frequently with higher tones.frequently with higher tones.

Make sure good visual contact is Make sure good visual contact is available for patient to read lips.available for patient to read lips.


Nervous System:Nervous System: Decline in the number of brain cells.Decline in the number of brain cells. Nerve impulses are slower because of delayed Nerve impulses are slower because of delayed

reaction time.reaction time. Neuron death is not a normal part of aging it is Neuron death is not a normal part of aging it is

due to disease process.due to disease process. Memory changes are common.Memory changes are common. Short term memory may decline while long Short term memory may decline while long

term is intact.term is intact.


Older adults may not have been formally Older adults may not have been formally educated yet they have learned thru educated yet they have learned thru experience.experience.

Everyone is capable of learning though out Everyone is capable of learning though out their life span.their life span.

Mental status may be assessed using the Mental status may be assessed using the Mental Status Questionnaire or the Mini-Mental Mental Status Questionnaire or the Mini-Mental State Examination. Theses assess orientation, State Examination. Theses assess orientation, memory, language, and motor skills.memory, language, and motor skills.


Older adults may experience insomnia.Older adults may experience insomnia. Sleep patterns change with age. Older Sleep patterns change with age. Older

adults wake up frequently and feel that adults wake up frequently and feel that they have not slept at all.they have not slept at all.

May resort to hypnotics which may May resort to hypnotics which may complicate matter more.complicate matter more.

Regular bedtime.Regular bedtime.


Encourage a nap during morning hours Encourage a nap during morning hours instead of afternoon.instead of afternoon.

Exercise and activity throughout the day Exercise and activity throughout the day increase the chances of falling asleep at increase the chances of falling asleep at night.night.

Older adults need a familiar environment Older adults need a familiar environment to be able to sleep well.to be able to sleep well.


Nervous system:Nervous system: DeliriumDelirium DementiaDementia Alzheimer'sAlzheimer's StrokeStroke


Polypharmacy Page 1119.Polypharmacy Page 1119. Finances Finances HousingHousing Loss, Grief, and DepressionLoss, Grief, and Depression Healthy People 2000 set forth goals to prevent Healthy People 2000 set forth goals to prevent

health risks, unnecessary disease, disability, health risks, unnecessary disease, disability, and death.and death.

Intent is to focus on improving quality of life.Intent is to focus on improving quality of life.

DisclaimerDisclaimer

This product was funded by a grant awarded under the This product was funded by a grant awarded under the President’s Community- Based Job Training Grants as President’s Community- Based Job Training Grants as implemented by the U.S. Department of Labor’s implemented by the U.S. Department of Labor’s Employment & Training Administration. The information Employment & Training Administration. The information contained in this product was created by a grantee contained in this product was created by a grantee organization and does not necessarily reflect the official organization and does not necessarily reflect the official position of the U.S. Department of Labor. All references position of the U.S. Department of Labor. All references to non-governmental companies or organizations, their to non-governmental companies or organizations, their services, products, or resources are offered for services, products, or resources are offered for informational purposes and should not be construed as informational purposes and should not be construed as an endorsement by the Department of Laboran endorsement by the Department of Labor..

welcome to geriatrics chapter 33 health promotion and care of the older adult

Documents

older person

older americans

older adultoverview

centenarians older

years of age

older adult population

interactions older adults

nations older citizens