Click to edit Master subtitle style Nursing Elective Course

Geriatric Nursing
7/15/12

Terms geriatrics- study of old age

including physiology, pathology, dx., & treatment of diseases of old adults
gerontology-

broader, the study of the aging process including biological, psychological, & sociological
gerontologic or gerontic nursing7/15/12 specializes in care of the elderly

Aging

normal process of time related change starting with birth & continuing throughout life person ages influenced by genetics lifestyle availability & quality of health care socioeconomics

way

old

age- final phase of life by 2030- 69.4 Million (8 Mil. over 85)
7/15/12

predict 23%

over 65 while only 18% under 18

Terms Old Age

definition

varies with frame of

reference
society

indicates age 65 as beginning of old age young-old- 65-74 middle-old-7/15/12 75-84

Terms

life span- maximum number of years person can live under the best of conditions in absence of disease life expectancy- average number of years a person can be expected to live 77.7 years 80% have @ least 1 chronic illness, 50% have 2 Million older- 4.4 Million (14.5%) difficulty with @ least 1 ADL (eating, bathing, dressing, transferring, 7/15/12 toileting)

2007: over 34

Myths vs Reality
1. families do not care for elder- 80% do take care 2. elderly- alone & deserted 67% live in family setting 66%- child within 30 minutes 62%- weekly visits 76%- talk weekly 3. sickness & aging synonymous almost 50% rate health as good or 7/15/12 excellent

Myths vs Reality
4. incapable of learning- although slowed due to reflexes, capable of learning new things 5. no longer interested in sexuality/ sexual act sexuality (lifelong need) can provide intimacy & love without sexual relations 6. constipation/ incontinence- expected never normal constipation due to inactivity or diet
7/15/12 incontinence- seek medical help

Myths vs Reality
7. senility- expected result of age senility (dementia found in elderly) dementia- result of disease- not aging 8. elderly financially impoverished median net worth- $86,300 poverty rate- 12.9% median income- $28,983 9. spend last years in nursing home
7/15/12 about 5% in nursing home

1. personal hygiene
bath 2-3/ week lotion prn

Health Promotion & Maintenance

shampoo 1-2/ week keep nails short dental supervision try to make dressing easier (loose clothing, zippers, velcro)

2. exercise
7/15/12 individual planned

Integumentary

skin thinner

Normal Aging Changes

wrinkles gray hair skin drier & more susceptible to irritation change in pigmentation (age or liver spots) nails- thick & brittle less efficient cooling system 7/15/12 less tolerance to temperatures

less subcutaneous tissue

Normal Aging Changes

Nervous

slowed reactions altered sleep cycle short term memory loss impaired senses Recommend at risk for accidents assist ADL 7/15/12 prn

Normal Aging Changes

Sensory

vision
presbyopia reading glasses problem with blue vs green difficulty adjusting to dark-light changes (night blindness) Recommend

adequate lighting avoid glare vision aids

7/15/12

Normal Aging Changes

Sensory hearing
presbycusis problem with some consonants cerumen accumulation Recommend
low tone speaking voice reduce background noise face person enunciate clearly moderate pace gestures prn
7/15/12

Normal Aging Changes

Respiratory

decreased gas exchange & cough efficiency decreased activity tolerance more vulnerable to infection Recommend
exercise no smoking not in smoking areas force fluids flu vaccine
7/15/12

avoid exposure to infection

Normal Aging Changes

Reproductive

decreased hormone production menopause in female decreased vaginal secretions penis & testes decrease in size sperm production slowed Recommend
sexual desires & activity decline but not disappear water-soluble lubricant 7/15/12 sexual counselor prn

Normal Aging Changes

Musculoskeletal

osteoporosis pathologic fractures muscles lose strength, flexibility, & endurance height loss changes in posture Recommend
high Ca, low Ph exercise handle gently
7/15/12

Normal Aging Changes

Cardiovascular

heart disease leading cause of death heart valves-thicker & stiffer arteries lose elasticity & accumulate deposits decreased response to stress B/P increases cardiac output decreases Recommend
exercise no smoking weight control
7/15/12

Normal Aging Changes

GI

decreased motility decreased teeth ill fitting dentures decreased saliva constipation
lack of bulk prolonged use of laxatives ignore urge to defecate drug side effects
7/15/12

emotional problems

Normal Aging Changes GI Recommend

regular dental & oral care small frequent meals sit up after meals no heavy activity after
meals
7/15/12 antacids with supervision

Normal Aging Changes

Urinary
decreased nephron activity lose of muscle tone results in more frequent voiding retention, frequency, urgency, & incontinence common Recommend
ready access to toilet, void regularly pelvic floor exercises
7/15/12 avoid bladder irritants (caffeine, ETOH, sweeteners)

Normal Aging Changes

Endocrine change in hormones decreased basal metabolic rate (BMR)

Immune

decreased function more susceptible to infection & disease 7/15/12

Mental Health Disorders

1. depression
a. most common affective, mood, or functional disorder b. can be reaction to loss of independence, status or spouse c. some medications d. physical illness & changes e. nursing
encourage self expression & esteem improve appearance provide structure7/15/12 & routine

Mental Health Disorders 2. aggressive behavior a. abnormal anger, rage, or hostility b. result of anxiety, stress, guilt, insecurity, forced dependence c. nursing
7/15/12 express feelings

Mental Health Disorders

4. rehabilitation for mental problems a. reality orientation b. remotivation c. reminiscence d. cognitive training e. relaxation therapy
7/15/12

Role Changes
1. crisis- sudden, not able to plan for appropriate replacement, substitute not readily available, stress producing 2. gradual- develop slowly & allow time for preparation 3. changes generally crisis-forced retirement, loss of spouse, illness, friends move away or die, family relocate or assume new roles decreasing time for relationship
7/15/12 4. role losses- work (no longer bread winner), family (no longer decision

Alterations in Life-style
1. employment
increase in number of older females working decrease in number older males working part-time employment more common early retirement involuntary limitations (health, sensory or perceptual alterations, decline in strength, endurance, & speed) strengths (reliability, dependability, 7/15/12 knowledge, expertise, experience)

2. retirement

Alterations in Life-style
mandatory age raised to 70 health problems major cause of voluntary retirement increased leisure time stressful when decreased ability to handle stress tremendous anxiety loss of daily routine & income
7/15/12

Alterations in Life-style
economic

fixed incomes frequently below nation's poverty levels (1 of 10) costs increase buying power decrease many not receiving full benefits due to lack of knowledge or inability to find out resources
lack of mobility health problems
7/15/12

penalties of losing social security benefits

health

40% more than one chronic disease

increase

in health care needs & costs

Alterations in Life-style
7/15/12

Alterations in Life-style
housing

prefer to remain independent live with spouse, alone, or with family own home alternatives (mobile homes, retirement communities, foster homes, life care facilities, nursing homes, homes for the aged, convalescent homes, rest homes, house sharing, public housing, rooming houses, hotels for single room occupancy) require special assistance (transportation, 7/15/12 meals, health hotlines, house cleaners,

Alterations in Life-style
recreation

more time available problems (cost, health, decreased energy, lack of incentive, sensory losses, lack of environmental aids, lack of conveniently located facilities) most depend on family alternatives (religious, community activities, day care, senior citizen centers, adult education, cultural events)
7/15/12

Intelligence
test

scores decline but due to slowed responses not actual ability capacity continues

learning memory

short term concentration & retention decline remote generally better

personality

basically unchanged
7/15/12

Drugs & Elderly

account average

for 34% of Rx. & 40% of OTC more than 11 per year

decreased

dosage due to decreased absorption, distribution, metabolism, & excretion

Recommend

education administration times compatible with 7/15/12 lifestyle

Community
95% 31%

live in community live alone (40% female, 74% male)

married 48%

females widowed but only 15% males (more remarry) have living children

81%

7/15/12

Elder Abuse
active

or passive act or behavior that is harmful to the elderly violence (battering, sexual) neglect

physical personal mental

anguish (threat of institutionalization, social isolation, sensory deprivation) exploitation of rights (confinement or 7/15/12 restraint)

financial violation

Safety
accidents

leading cause of death falls most also fires & MVA more likely
decreased sense increased reflex time muscle weakness confusion, forgetful
7/15/12 improper footwear

Safety
prevention

short or 3/4 sleeve no long garments chairs with arms no slip wax on floors, no scatter rugs or deep pile avoid clutter rubber tips on canes tong reachers rather than stools or ladders
7/15/12 temperature controlled faucets

Safety
handrails, high toilet seats, shower chairs night light side rails on bed prn telephone by bed proper lighting stair rails, colored strips on step edges no frayed wires readily available emergency numbers smoke detectors crime prevention assessment
7/15/12

Personal Space
many

are set in ways

prefer

to be in familiar place with memories allow as long as possible

7/15/12

should

Medicare
federal

social insurance program designed to provide health care to elderly entitled to social security benefits A- hospital B- medical

part part

(voluntary must pay additional fee out-patient

7/15/12

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