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Chapter 19
Senior Health
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
Aging is a natural process that
affects all living organisms.
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Chronological age
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The young-old (ages 65-74)
 The middle-old (ages 75-84)
 The old-old (ages 85 and older)
 The elite-old (more than 100 years old)
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Functional age
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Functional ability and the ability to perform
activities of daily living (ADLs)
 A better measure of age than chronological age
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
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Why Do People Age?
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Biological theories
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Events that occur randomly and accumulate over
time (stochastic theories)
Predetermined aging (nonstochastic theories)
Psychosocial theories: how one experiences
late life (behavioristic)
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Disengagement theory—withdrawal, decreased
interaction
Activity theory—remaining active and involved is
necessary to maintain life satisfaction
Continuity theory—continue through life as in
previous years
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
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Demographic Characteristics
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Americans are living longer than ever before
and the older population will continue to grow.
Older population is becoming more diverse.
Number of seniors differs by geographic
location.
Older women outnumber older men.
Older men are more likely than older women
to be married.
Educational attainment has increased among
older adults.
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
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Demographic Characteristics (Cont.)
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Older women are more than twice as likely as
older men to live alone.
Older adults want to live in their own home for
as long as possible—“age in place.”
Alternative housing options are available with
services to help seniors.
With aging, a good percentage of income is
spent on health care.
The proportion of the older population living in
poverty has decreased but is affected by
gender, marital status, race, and ethnicity.
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
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Psychosocial Issues and
Role Changes Affecting Seniors
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Retirement
Relocation
Widowhood
Loss of family and friends
Possibly raising their grandchildren
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
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Physiological Changes of Aging
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Occur in all body
systems
Rate and degree of
changes are highly
individualized
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Influenced by:
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Genetic factors
 Diet
 Exercise
 The environment
 Health status
 Stress
 Lifestyle choices
 And many other
elements
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
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Wellness is different than “good health.”
Wellness exists at one end of a
continuum with illness at the other end.
Health promotion programs focus on
helping individuals to maintain their
wellness, prevent illness, and manage
any chronic illnesses that the individual
may have. Preventive health services
are valuable in improving the individual’s
health status to maximum wellness
potential.
– Nies & McEwen (2015)
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
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Recommended Health Practices
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Encourage recommended health care
screenings and examinations.
Encourage physical activity and fitness.
Evaluate the nutritional status and needs of
older adults.
Monitor chronic illnesses.
Monitor medication use.
Monitor and accommodate sensory
impairments.
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
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Recommended Screenings and Exams for
Health Promotion and Disease Prevention
For All Older Adults
 Complete physical: Annually
 Blood pressure: Annually
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Blood glucose: Annually
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More often if diabetic or at risk
Serum cholesterol: Every 5 years
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More often if hypertensive or at risk
More often if at risk
Fecal occult blood test: Annually
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
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Recommended Screenings and Exams for Health
Promotion and Disease Prevention (Cont.)
For All Older Adults
 Sigmoidoscopy: Every 3 to 5 years
OR
 Colonoscopy: Every 10 years
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More often if high risk
Visual acuity and glaucoma screening: Annually
Dental exam: Annually for those with teeth;
cleaning every 6 months (every 2 years for
denture wearers)
Hearing test: Every 2 to 5 years
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
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Recommended Screenings and Exams for Health
Promotion and Disease Prevention (Cont.)
For All Older Women
 Breast self-exam: Monthly
 Clinical breast exam: Annually
 Mammogram: Every 1 to 2 years if age 40 or older
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Pelvic exam and Pap smear: Annually
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Check with HCP if 74 years+
Check with HCP about discontinuation at 65 or older
with three consecutive negatives exams and no
abnormal in previous 10 years and not otherwise at
risk
Digital rectal exam: Annually with pelvic exam
Bone density: Once after menopause
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More often if at risk
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
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Recommended Screenings and Exams for Health
Promotion and Disease Prevention (Cont.)
For All Older Men
 Digital rectal exam and prostate exam: Annually
 Prostate-specific antigen (PSA) blood test: Annually
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
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Immunizations for Older Adults
http://www.cdc.gov/vaccines/schedules/downloads/adult/mmwradult-schedule.pdf.
Immunizations for All Older Adults
 Tetanus, diphtheria, pertussis: Every 10 years
 Influenza (flu) vaccine: Annually
 Pneumonia vaccine: Once after age 65
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Ask physician about booster every 5 years
Hepatitis A and B: For those at risk
Herpes zoster (shingles): One-time dose
Varicella: If evidence of lack of immunity and
significant risk for exposure
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
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Encourage Physical Activity and
Fitness
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Physical activity …
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Improves functional status
Reduces blood pressure and cholesterol
Decreases insulin resistance
Prevents obesity
Strengthens bones
Reduces falls
Walking is one of best forms of exercise.
Barriers: Pain, fatigue, lack of access to
safe areas, impairment in sensory
function and mobility
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
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Assess Nutritional Status
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Poor nutrition in older adults is common.
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Obesity in adults over 70 years and older has been
increasing.
Normal physiological changes related to aging affect
nutritional status.
Income, functional status, medications, social
isolation, transportation, and dependence on others
affect nutrition as well.
Recommend myplate.gov for assessment
of eating patterns.
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
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Nutrition Checklist for Seniors:
Warning Signs of Poor Nutritional Health
D isease
E ating poorly
T ooth loss/mouth pain
E conomic hardship
R educed social contact
M ultiple medications
I nvoluntary weight loss/gain
N eed assistance in self-care
E lder years (>80 years old)
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
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Monitor Chronic Illnesses
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Chronic disease is the leading cause of
death among persons 65 years and older.
The prevalence of chronic disease
increases with aging; many older adults
have at least two chronic conditions.
The most common conditions are arthritis,
hypertension, and diabetes.
Chronic illness is a major cause of
disability and may cause limitations with
activities of daily living (ADLs and IADLs).
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
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Monitor Medication Use
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Older adults consume more than one third of all Rx drugs, as
well as many OTC drugs and “folk” remedies.
Age-related changes influence the effects of drugs.
Polypharmacy may lead to drug interactions and dangerous
adverse reactions.
Most emergency hospitalizations for adverse drug events are
caused by a few commonly used medications.
Closely monitor medication use in homes to ensure safety.
Older adults should be educated about potential adverse
reactions, including drug-drug and drug-food interactions.
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
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Monitor and Accommodate
Sensory Impairment
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Visual impairment impacts social abilities, depression,
falls, and communication.
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Hearing loss one of most common conditions affecting
older adults.
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Cataracts, macular degeneration, diabetic retinopathy,
and glaucoma
Presbycusis and tinnitus
Dental problems are neglected because of inadequate
dental care, limited mobility and transportation, poor
nutrition, myths, lack of finances and reimbursement.
Incontinence affects quality of life and is a symptom of
underlying problems.
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
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Elder Safety and Security Needs
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Falls
Traumatic brain
injury (TBI)
Driver safety
Residential
fire-related injuries
Cold and heat stress
disorders
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Elder abuse
Crime
Psychosocial
disorders
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Anxiety disorders
 Depression
 Substance abuse
 Suicide
 Alzheimer’s disease
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
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Alzheimer’s Disease
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Slowly progressive brain disorder: begins with
mild memory loss; progresses through stages
to total incapacitation and eventually death.
Diagnosing is difficult; often reached after all
other conditions ruled out.
Assessment tools include:
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Mini-Cog, MIS, and GPCOG
 Clock drawing
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No cure and limited treatment options are
available.
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
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Alzheimer’s Disease (Cont.)
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Behavioral and physical changes create
many challenges for caregivers.
Management strategies include:
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Appropriate use of available treatment options
Management of coexisting conditions
Coordination of care among professionals and
caregivers
Participation in activities and adult day care
programs
Support groups and support services
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
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Spirituality
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Involves “finding core meaning in life, responding to
meaning, and being in relationship with God/Other”
(Manning, 2013)
Spirituality has health benefits—resilience
Nurses should address spiritual needs and concerns
as part of holistic care.
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Interventions include nurses’ presence, active listening,
caring touch, reminiscence, prayer, hope, nonjudgmental
attitude, facilitation of religious practices, referral to spiritual
care experts.
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
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End-of-Life Issues
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Patient Self-Determination Act (PSDA)
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Federal law enacted in 1990
Requires health care facilities that receive
Medicare and Medicaid funds to ask patients on
admission if they possess advance directives.
• Living wills
• Durable power of attorney
• DNR (do-not-resuscitate) order
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
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Nurse’s Role in End-of-Life Issues
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Discuss and educate patients about end-oflife issues.
Inform other members of the health care
team about advance directives.
Make sure that the document is visible and
accessible in the patient’s chart.
Encourage patients to discuss their wishes
with their family.
Encourage patients to discuss with physician
so it becomes part of medical record.
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
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