Download Key Points 2- Ignatavicius: Medical

Ignatavicius: Medical-Surgical Nursing, 8th Edition; Chapter 02: Common Health Problems of Older
Adults; Key Points
Priority concepts applied in this chapter include NUTRITION, MOBILITY, SENSORY PERCEPTION, COGNITION,
ELIMINATION, and TISSUE INTEGRITY.
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Learning about the special needs of older adults is important for health care professionals in a variety of
settings.
The percentage of people older than age 65 years in the United States is about 13%.
The four subgroups of the older adult population are the young old, middle old, old old, and elite old.
The fastest growing subgroup is the old old, sometimes referred to as the “advanced older adult” population.
Members of this subgroup are sometimes referred to as the “frail elderly,” although a number of 85- to 95year-olds are very healthy.
Frailty is a clinical syndrome in which the older adult has unintentional weight loss, weakness and exhaustion,
and slowed physical activity, including walking. Frail elders are also at high risk for adverse outcomes.
The vast majority of older adults live in the community at home or within an environment that offers
assistance. Only 5% are in long-term care (LTC).
Considerations of multiple older adult health issues in other types of institutions (prisons) include alcohol and
substance abuse and poor NUTRITION.
The number of homeless older adults, including veterans of war, continues to rise. These individuals are often
faced with chronic health problems, including mental/behavioral disorders.
HEALTH ISSUES FOR OLDER ADULTS IN COMMUNITY-BASED SETTINGS
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Health status can affect the ability to perform daily activities and participate in social activities.
Increased dependence on others may have a negative effect on morale and life satisfaction.
Loss of autonomy is a painful event with far-reaching effects.
Older adults often experience personal losses that can affect their sense of control over their lives.
Many older adults are not prepared for retirement in view of increased expenses and income that is not
adequate to meet basic needs, health care treatments, and medications.
Many are discharged from health care facilities and require home health services or live in long-term care
settings.
Coordinate care by collaborating with members of the health care team when providing care to older adults in
the community or inpatient setting.
Provide information regarding community resources for older adults to help them meet their basic needs.
Common health issues and geriatric syndromes affecting the older adults include decreased nutrition and
hydration, decreased mobility, stress and loss, accidents, drug use and misuse, mental health/cognition
problems (including substance abuse), and elder neglect and abuse.
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Decreased NUTRITION and hydration are two health problems experienced by older adults.
o Reduced income, chronic disease, fatigue, and decreased ability to perform activities of daily living
are other factors that contribute to inadequate nutrition among older adults.
o Some older adults are at risk for geriatric failure to thrive (GFTT)—a complex syndrome including
under-nutrition, impaired physical functioning, depression, and cognitive impairment.
o Many older adults are at risk for under-nutrition, most often protein-calorie malnutrition, also known
as protein-energy malnutrition.
o Older adults may respond to loneliness, depression, and boredom by not eating.
o Diminished senses of taste and smell often result in a loss of desire for food, and poor dental status
can affect their ability to chew.
o The risk for dehydration is greater in older adults because of many factors, including diuretics,
incontinence concerns, and decreased thirst mechanism.
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Decreased MOBILITY
o Exercise and activity are important for older adults as a means of promoting and maintaining health.
o Teach older adults about the benefits of regular physical exercise.
Copyright © 2016, 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.
Key Points
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Stress and Loss
o Stress can speed up the aging process over time, or it can lead to diseases that increase the rate of
degeneration. It can also impair the reserve capacity of older adults and lessen their ability to respond
and adapt to changes in their environment.
o Relocation stress syndrome is the physical and emotional distress that occurs after the person moves
from one setting to another and may cause sleep disturbance and physical symptoms, such as GI
distress.
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Accidents
o The biggest concern regarding accidents among older adults in both the community and inpatient
setting is falls.
 Older adults need to be aware of safety precautions to prevent accidents, such as falls.
 Incapacitating accidents are a primary cause of decreased mobility in old age.
 Changes in vision, touch, and motor ability can create challenges for older adults in any
environment.
o Motor vehicle accidents are the most common cause of injury-related death in the young old
population, those between 65 and 74 years of age.
 Health care professionals play a major role in identifying driver safety issues.
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Drug Use and Misuse
o Medication use in older adults is often a problem when they commit errors when self-medicating,
avoid needed medications, or have problems understanding their medication regimen.
o Physiologic changes of aging predispose older adults to toxic effects of medication; drugs are
absorbed, metabolized, and distributed more slowly. They are also excreted more slowly by the
kidneys.
o Older adults may not tolerate standard dosing traditionally prescribed for younger adults.
o Chronic disease added to physiologic changes of aging results in drug reactions with a more dramatic
effect and a longer time to correct.
o Older adults may commit errors when self-medicating, avoid needed medications, or have problems
understanding their medication regimen.
o Polypharmacy is the use of multiple drugs, duplicative drug therapy, high-dosage medications, and
drugs prescribed for too long a period of time.
o The Beers Criteria for Potentially Inappropriate Medication Use in Older Adults assessment tool is
very useful in screening for medication-related risks in older adults who have chronic health
problems.
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Mental Health/COGNITION Problems (including substance abuse)
o Decreased reaction time to stimuli and an impairment of memory for recent events are changes in
cognition that are age related.
o Two forms of competence exist: legal competence and clinical competence.
o If determined in court that a person is not legally competent, a guardian is appointed to make
financial and health care decisions.
o A clinically competent person is legally competent and capable of making clinical decisions.
o Depression is the most common, yet most underdiagnosed and undertreated, mental health/behavioral
health disorder among older adults. The Geriatric Depression Scale—Short Form (GDS-SF) was
developed as a basic screening measure for depression in older adults.
o Depression is broadly defined as a mood disorder that can have cognitive, affective, and physical
manifestations.
o Depression increases with admission to the hospital or nursing home.
o Dementia is a broad term used for a syndrome that involves a slowly progressive cognitive decline,
sometimes called chronic confusion.
o Delirium is an acute state of confusion. Delirium differs from dementia in that it is usually short term
and reversible, often occurring in unfamiliar settings.
Copyright © 2016, 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.
Key Points
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Confusion is not part of the normal aging process.
Promote sleep and rest for older adults to decrease the incidence of delirium and prevent falls. Screen
older adults for alcohol abuse or alcoholism and refer those with identified problems to appropriate
resources. The CAGE questionnaire has four items and is used frequently in primary care for
screening for alcohol misuse in older adults.
Elder Neglect and Abuse
o Neglect or abuse may occur in older adults, especially those who are dependent.
o The abuser is often a family member who becomes frustrated or distraught over the burden of caring
for the older adult.
o Abuse may be composed of neglect or failure to provide basic needs, physical abuse, financial
abuse, or emotional abuse.
The ways in which individuals adapt to old age depends on personality traits and coping strategies they have
used throughout their lives.
Many older adults return to work to help pay for health care and other expenses, and provide socialization.
HEALTH CARE ISSUES FOR OLDER ADULTS IN HOSPITALS AND LONG-TERM CARE
SETTINGS
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Older adults who are admitted to hospitals and long-term care settings such as nursing homes have special
needs and potential problems.
Many of these problems are similar to those seen among community elders.
Whereas nursing homes have multiple federal and state laws to prevent negative patient outcomes, hospitals
are not required to follow these protective laws.
The Joint Commission and other agencies have recently addressed some of the most common problems seen
in older adults.
Since 1996, the Hartford Institute for Gerontological Nursing has worked to ensure that all hospitalized
patients 65 years of age and older be given quality care.
The Fulmer SPICES framework was developed as part of the NICHE project and identifies six serious
“marker conditions” that can lead to longer hospital stays, higher medical costs, and even deaths. These
conditions are:
o Sleep disorders
o Problems with eating or feeding
o Incontinence
o Confusion
o Evidence of falls
o Skin breakdown
Use the SPICES assessment tool for identifying serious health problems that can be prevented or managed
early.
Follow The Joint Commission’s National Patient Safety Goals (NPSGs) and best practice guidelines to
prevent agency-acquired pressure ulcers.
Physical and chemical restraints should not be used for older adults until all other alternatives have been
tried. If necessary, use the restraint that is least restrictive first.
The most common accident among older patients in a hospital or nursing home setting is falling. A fall is an
unintentional change in body position that results in the patient’s body coming to rest on the floor or ground.
Maintaining TISSUE INTEGRITY is a major safety goal in the care of older adults. Prevention is key! The nurse
uses evidence-based treatment for pressure ulcers, shear injuries, and skin tears. Supervising unlicensed
assistive personnel in protecting fragile skin and coordinating interventions with the health care team is
necessary to prevent harm and promote healing.
Copyright © 2016, 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.