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Lewis: Medical-Surgical Nursing, 9th Edition

Chapter 5
Chronic Illness and Older Adults

Chronic illnesses are those that are prolonged, do not resolve spontaneously, and are
rarely cured completely.
Most chronic illnesses may be viewed as a trajectory with overlapping phases, in which
an individual moves from a level of optimum functioning, with the illness in good
control, to a period of instability where they may need assistance.
Corbin and Strauss identified seven tasks of those who are chronically ill. These include
managing and preventing crises, controlling symptoms, following the treatment regimen,
reordering time, adjusting to disease changes, preventing social isolation, and attempting
to normalize interactions with others.
Preventive health behaviors are those voluntary actions taken by an individual or group to
decrease the potential threat of illness.
o Primary prevention refers to measures that prevent the occurrence of a specific
o Secondary prevention refers to actions aimed at early detection of disease that can
lead to interventions to prevent disease progression.
o Tertiary prevention refers to activities (e.g., rehabilitation) that limit disease
progression or return the patient to optimal functioning.
Nurses play a critical role in the management of chronic conditions: planning of care,
teaching the patient and family, implementing strategies, and assessing patient and family
Self-management is an individuals ability to manage his or her symptoms, treatment,
physical and psychosocial consequences, and lifestyle changes in response to living with
a long-term disorder.
Demographics of Aging
The U.S. population of older adults is rapidly growing, becoming older and becoming
more ethnically diverse.
Factors contributing to a growing aging population include improved treatment of disease
through drug therapy, earlier detection of illness, and a greater emphasis on health
Attitudes Toward Aging
Copyright 2014 by Mosby, an imprint of Elsevier Inc.

Key Points


A number of myths and stereotypes about aging exist and are often supported by the
media. These can lead to errors in the assessment and care of older adults.
Ageism, a negative attitude based on age, can lead to discrimination and disparities in
health care provided to older adults.

Biologic Aging
Aging is defined as a progressive loss of physiologic function, the exact cause of which is
Biologic aging is a balance of positive (e.g., healthy diet, exercise, social support) and
negative (e.g., smoking, obesity) factors.
Age-Related Physiologic Changes
Age-related changes affect every body system; the age at which changes occur varies
from person to person.
It is important for you to assess for age-related changes in patients.
Most older adults live with at least one chronic condition, such as heart disease,
hypertension, diabetes, and arthritis.
Older women, who are likely to experience greater longevity, are particularly affected by
reduced financial resources and unequal access to health care.
Other vulnerable groups of older adults who may experience limited health care services
include those in certain geographic locations, the homeless, the poor, or those affected by
ethnic or cultural biases.
The frail older adult is one who is usually over age 75 years and has physical, cognitive,
or mental dysfunctions that may interfere with the ability to independently perform
activities of daily living (ADLs).
Elder mistreatment describes intentional acts by a caregiver or trusted other that cause
harm or serious risk of harm to a vulnerable older adult and/or neglect meeting the basic
needs of a vulnerable older adult. Such acts can include physical and/or mental abuse,
sexual abuse, medical abuse, financial exploitation, neglect, and abandonment.
Family members are perpetrators in approximately 9 out of 10 cases of domestic elder
abuse, neglect, and exploitation.
Low social support is a risk factor for both self-neglect and mistreatment of vulnerable
older adults by trusted others.
Most older adults are beneficiaries of at least one social or government program.
Social support can involve family, the community, religious organizations, social welfare
agencies, health facilities, and government support (Medicaid and Medicare).
Copyright 2014 by Mosby, an imprint of Elsevier Inc.

Key Points


Medicare is composed of four parts: A, B, C, and D. Part A covers inpatient hospital care
and limited skilled nursing facility care; Part B covers outpatient treatment and
physicians services; Medicare Advantage Plans, referred to as Part C, are offered by
private companies approved by Medicare; and Part D covers prescription drugs.
Home health care services require physician recommendation and skilled nursing care for
Medicare Part A reimbursement.
Medicaid is a state-administered program that assists eligible low-income persons. Since
it is state-administered, eligibility and coverage vary by state.


Many older adults remain in their residence and, if needed, are assisted through
community support, religious organizations, living adaptations, and housing assistance.
Older adults with special care needs include people who are in need of assistance with
ADLs, cognitively impaired, homebound, no longer able live at home, and/or the
homeless. The older adult may be served by adult day care, adult day health care, home
health care, respite care, and long-term care.
Continuing care retirement communities, congregate housing, and assisted living
facilities are housing options for older adults.
Legal concerns regarding advance directives, end-of-life care, estate planning, taxation,
and appeals are a concern for many older adults.
Ethical issues surrounding care of the older adult include using restraints, evaluating the
patients ability to make decisions, initiating resuscitation, treating infections, providing
nutrition and hydration, and financial and material exploitation by others.
The nurse plays a role in acknowledging when these issues are present and advocates for
an institutional ethics committee.
As a nurse caring for the older adult, you can advocate for accurate and comprehensive
assessments in which health and disease states are accurately diagnosed and actively
teach health promotion strategies.
The focus of a comprehensive geriatric assessment is to determine appropriate
interventions to maintain and enhance functional abilities of the older adult. It includes a
thorough history using a functional health pattern format, physical assessment, mood
assessment, mental status evaluation, ADL and instrumental ADL (IADL) evaluation, and
social-environmental assessment.
For the hospitalized older adult there are special concerns related to high surgical risk,
acute confusional state, health care-associated infection (HAI), and premature discharge
with an unstable condition.
ADLs, including bathing, dressing, eating, toileting, and transferring, are important for
you to assess in the older patient living with chronic illness.
Reducing disability through geriatric rehabilitation is important for quality of life of older
Copyright 2014 by Mosby, an imprint of Elsevier Inc.

Key Points


Age-related changes in pharmacodynamics and pharmacokinetics of drugs as well as

polypharmacy put older adults at risk for adverse drug reactions.
Depression is the most common mood disorder in older adults.

Copyright 2014 by Mosby, an imprint of Elsevier Inc.