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Health Alterations in Older Adults Janet Duffey, RN, MS, APRN, BC Think About This…. A group of Florida senior citizens were talking about their ailments. "My arms are so weak I can hardly hold this cup of coffee." "Yes, I know. My cataracts are so bad I can't even see my coffee." "I can't turn my head because of the arthritis in my neck." "My blood pressure pills make my dizzy." "I guess that's the price we pay for getting old." "Well, it's not all bad. We should be thankful that we can still drive." General Changes Non regeneration Loss of neurons in cerebral cortex Decreased oxygen, blood flow Impaired thermoregulation Susceptibility in choline Dopamine Alteration in functional mobility Neurological Diseases Parkinson’s: pill rolling, tremors, forward gait, mask like expression, depression Stroke (CVA): location, right brain, left brain, motor tracts Hemorrhagic, occlusive, thrombotic TIA’s – mini-thrombotic episodes resolving in 24 hours or less CVA’s Effects of CVA’s – – – – – – – language Speech Sensation perception behavioral style memory and holistic assessment Expressive aphasia (Broca’s) frontal lobe damage Receptive aphasia (Wernike’s) left hemi in temporal lobes Impact of CVA Overlooking Confusion Poorly understood event Multiple causes Misdiagnosis as “untreatable” Range of causes from age related memory loss to pathological change in brain Physical dysregulation: sleep, temperature, electrolytes, sensory overload Nursing Interventions for Confusion Baseline mental status exams Detect and report: insomnia, distractibility, hypersensitivity, c/o poor recall, nightmares Structure environment for moderate mental and physical stimulation Limit duration of activity Evaluate new / added meds carefully Confusion Causes of Acute Confusion Metabolic Drug toxicity or side effects Drug withdrawal Electrolyte imbalance Endocrine dysfunction Hypoxia Infection and sepsis Alzheimer’s Disease Genetic predisposition Presence of amyloid plaques & neurofibilary tangles (key finding on scans & autopsy) Reduced presence of choline required for cognition (major biochemical change) Dementia: Early Stage Mood change Poor judgment Getting lost Difficulty with numbers & money Withdrawal or depression Middle Stage AD Gross memory impairment Aphasia: speech disturbance Loss of impulse control Anxiety Wandering Confabulation Progressively lowered stress threshold Impaired self-care due to judgment Late Stage AD Dysphagia with risk for aspiration Impaired speech, little or no communication Immobile, non-ambulatory Totally dependent in all activities of daily living Morbidity by aspiration pneumonia or sepsis common Rx: Cholinesterase Inhibitors Cholenergic Drugs: Cognex, Aricept Rivastigmine, improving concentration of acetylholine Memantine: newly approved Side effects: nausea, bradycardia, elevated liver function studies Used in early to middle stages Behaviors in Dementia Perseverance Tactile wandering Recreational Purposeful “Sundowning” Gross agitation Hallucinations Delusions Interventions for Behaviors Determine underlying need Check for pain, hunger, toileting issues Decrease stress if possible Encourage rest periods Engage in activities related to premorbid personality and role PRN medications as a last resort, sparingly Non-AD Dementias Pick’s Disease Lewy Body Dementia Vascular Dementia – – – – Risk factors MRI. CT findings Prevention Treatment of symptoms similar to AD Renal / Urinary System Renal function Hydration Obstructive conditions Incontinence – – – – Stress Urge Overflow Functional Interventions Moderate fluid intake Regular toileting Treatment of infection Estrogen therapy Timing of diuretics Medication assessment for contributors Bladder retraining Changes in Skin Easily torn & blistered Decreased sensation leads to risk for injury Impaired thermoregulation Dryness Photo aging, cancers, basal cell epitheliomas, squamous cell carcinomas, multiple melanoma Increased risk for fungal infections Implications for nursing care: - Teaching to prevent sun exposure - Avoid excessive bathing - Role of nutrition and hydration - Pressure relief measures - Assessment: Braden Pressure Scale Pressure Ulcers in Elderly Prevalence varies by setting Risk factors for elderly – Acute immobility due to illness – Paralysis – Hip fracture – ICU/Critical care units – Nutritional state Braden’s Conception of Risk Decreased mobility Decreased activity Decreased sensory perception Increased: moisture, friction, shear Poor nutritional intake Advanced age Impaired circulation Alterations in GI Function Decreased GI acidity Constipation Changes in appetite Role of dental problems Diverticulosis Colon cancer Self management of colostomy Interventions for Constipation Constipation vs. obstruction Definition of “regularity” Establish fluid intake of 2000cc daily High fiber diet: bran, fruits, vegetables, whole grains Limit use of enemas and stimulants which cause more dehydration Alterations in MS Status Osteoarthritis Rheumatoid arthritis Osteoporosis Falls Fractures: vertebral, pelvis, hip, shoulder, wrist Normal: decreased muscle mass, less elastic, shrinking height Interventions for MS Diet, calcium, vitamin D HRT: estrogen Exercise Safety measures – Hazards of immobility – Identification of appropriate activities – Fall prevention & home safety Risk Factors for Falls Sensory deficits Cardiac contributors Neurological Urological Pharmacological Alcohol Environment Fall history Interventions for Falls Identify fear of falling Increase activity Strengthening exercises Orthostatic monitoring Use of assistive devices Safe, non-skid footwear Correct sensory deficits Plan how to get help after a fall Remove known hazards: rugs, clutter Identify activities requiring supervision / assistance Teach caregivers proper lifting or transfer techniques