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Preventing Functional Decline
through SPICES
Mary Spear, RN-BC, MSN, GNP
Geriatric Clinical Nurse Specialist
Objectives
 Define components of SPICES
 Identify Geriatric Syndromes associated with SPICES
 Identify three (3) interventions to prevent functional
decline
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Functional Decline Prevention
 Functional ability = indicator of health
 Goal:
Goal of interventions is to enable elders to function
at highest level despite the presence of age related
changes, risk factors, and disease
(Miller, C. 2012)
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• Think: FUNCTION
• Think: MAXIMIZE FUNCTION
Gawande, A. (April 30, 2007). The Way We Age Now.
The New Yorker Annals of Medicine
http://www.newyorker.com/magazine/2007/04/30/the-waywe-age-now
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Educational Resources
 Hartford Institute for Geriatric Nursing
Hartfordign.org/practice/try_this/
 NICHE – Nurses Improving Care of HS Elders
www.nicheprogram.org
Local universities – UC Berkeley, UCSF, Stanford
Professional Organizations
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Care of the Geriatric Patient
 Complexity of care
 Geriatric Syndromes
 Syndrome is a group of signs and/or symptoms that
occur together & characterize a
particular abnormality
 Underlying all of these issues is the
presence of multiple problems and
causes rather than only one or two
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SPICES
 S
Skin Breakdown
 P
Problems with eating or feeding
 I
Incontinence
 C
Confusion
 E
Evidence of Falls
 S
Sleep Disorder
(Hartford Institute of Geriatric Nursing, 2012)
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AGE-RELATED CHANGES
 SKIN – epidermis changes (thins, loss of strength and elasticity),
decreased sweat glands, decreased blood flow to skin, loss of
subcutaneous fat
 PROBLEMS with Eating/Feeding – decreased taste buds, thirst
perception, muscle strength for chewing, saliva, teeth, gag reflex, GI
acid, stomach emptying, absorption in small intestine, decreased
sense of smell
 INCONTINENCE – reduced bladder elasticity, muscle tone,
capacity, increased postvoid residual, nocturnal urine production,
BPH in males, prolapse in females
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AGE-RELATED CHANGES
 Confusion/Cognitive Decline – decrease in neurons,
weight of brain, decline in ability to learn complex information,
delayed response time, minor loss of recent memory, decline in
ability to do complex tasks requiring multiple steps
Pathological conditions of cognitive impairment seen
with the older adult are:
Depression
Delirium
Dementia
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AGE-RELATED CHANGES
 EVIDENCE OF FALLS – decline in muscle mass and strength,
decline in size, number, quality of skeletal muscle fibers, bone loss,
decreased cartilage in joints, reduced joint stability, intervetebral disc
degeneration
 SLEEP – normal changes in circadian patterns (sleep-wake) result
in nocturnal awakenings, with increase in transient arousals,
increase in time until sleep onset, decreased periods of REM sleep
(restorative sleep)
(Brown, J., Bedford, N, White, S. 1999)
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Age Related Sensory Changes
 Vision
Presbyopia
Cataracts
Glaucoma
Macular Degeneration
 Hearing
Presbycusis
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Age Related Sensory Changes
 Taste
4 basic tastes: Sweet, Salty, Sour, Bitter
Loss of taste buds
 Smell
Decrease in number of sensory cells in nasal lining
 Touch
Decreased sensation; safety issues
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Case Study
 Pt. is a 75 y.o. female admitted after found on floor in
home. She has had numerous falls, is unable to care for
self, though refuses to leave her home. MM is a widow,
husband died 4 yrs. Ago. She has no children nor
relatives in the area.
MM has a large dog at home and states, “I like animals
more than I like people.”
 Issues – SPICES
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References
 Brown, J., Bedford, N., White, S. (1999). Gerontological
Protocol for Nurse Practitioners. Lippincott Williams &
Wilkins
 Miller, C. (2012). Nursing for Wellness in Older Adults,
6th Ed. Philadelphia, PA. Wolters Kluwer
Health/Lippincott Williams & Wilkins
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