Nursing Care of Older

Adults

Janet Duffey, RN, MS, APRN, BC

Aging Populations

Demographics

Population trends: Aging baby boomers

Health care system projections

Distinguishing characteristics
Aging & Ageism

Youth culture
Stereotypes of elderly
Minimization of
functionality
Focus of some theories on
aging
Verbal statements
Non-verbal
Why do we age? Biological
theories on aging
Cross linking

Free radicals

Neuroendocrine

Autoimmune
reactions
Psychosocial Theories

Disengagement

Activity

Continuity

Age stratification
Implications of Aging Theories

Past experiences in life

Health beliefs & values
Adjustment to limitations
Indications for wellness
Changes view of aging equates to illness
Cultural Interpretation of Aging

Physical traits
Functional
Symbolic
Numeric age
Status
Role of aged individuals
Meaning of aging
Expectations of aging
experience
Aging

Personal philosophy
Societal view
Caregiving systems
Impact of ageism, on
clients, individuals &
nursing
Factors influencing health and
aging: Positive or Negative
Culture

Ethnicity

Stress management -
resiliency

Coping abilities
Contributors to Health
Alterations
Excessive stress

Underlying disease(s)

Nutritional deficits

Drug induced effects

Falls and trauma

Health Promotion

"... A multidimensional
pattern of self-initiated
actions and
perceptions that serve
to maintain or enhance
the level of wellness."

Pender
Health Promotion Activities

Health assessment
Support esteem in appearance
Physical activity
Retirement (pro and con)
Part-time employment or volunteer
Social activity
Social support
Support sexuality
Nursing in Geriatric Settings

Uses the nursing process in ongoing

manner, not just one time
Contributes to the treatment team
Data systematically collected, ongoing
Nursing diagnoses derived from
assessment
NCP developed with patient and
significant other and problems
prioritized
Health Promotion Activities

Enc. and facilitate participation in plan

Give choices: food, grooming, activities

Facilitate care in least restrictive setting

Explore opportunities in community

Anticipate changes in mental and physical

health
Legal Issues Associated With
Aging
Consent for treatment
Establishing competence
Use of restraints
Injuries
Consent for participation in
research
Maintenance of patient rights
Advanced directives
Do not resuscitate orders
 Elder Abuse

Elder maltreatment" refers to the seven types

of abuse and neglect are physical abuse, sexual
abuse, emotional or psychological abuse,
financial or material exploitation, abandonment,
neglect, and self-neglect.
At risk: female, frail, 80+, dependent on child or
spouse
Mandatory reporting yielded 18% of all
reports, families
Alterations in Sensory
Function
Vision Changes

Accommodation
Narrowed visual field
decreased at periphery
Opacity of lens
Steropsis
Altered color perception
Light sensitivity
Macular degeneration
Assessing Vision

History
Near focus
Distance vision
Peripheral testing
General assessment of function / ADLs and
IADLs
Cataracts

Interim lenses
Anticipate post-op course
Intraocular-lens implants
Precautions
Avoidance of increased intraoccular
pressure
Antibiotic / anti-inflammatory eye drops
 Alteration in Hearing

Functional, emotional, social impact

Affects 28-55% older adults
Presbycusis: bilateral, gradual decline
Sensoryneural type of impairment
Volume and high frequency consonants
Assessment of Hearing

Onset
Watch test
Speech discrimination: fair,
sun, skies, shout, fun, sun
Conversational responses
Secondary complaints:
tinnitus, pain, conversational
difficulties
Interventions for Hearing
Impairment
Determine presence of hearing difficulty
Encourage acceptance and USE of hearing
devices
Analog aids
Digital programmed aids
Radio / television devices
Telephones
Maintenance
Hearing Aid Batteries
Verbal Communication

Slightly slower rate

Increase volume with moderation
Get patient's attention before
speaking
Shorter sentences
Lower voice pitch
Remove distractions
Provide information visually
Non-verbal communication
Identify denial/embarrassment
Touch & Older Adults

Increased need

Assessment by functional
measures

Sharp / dull response

Protective measures

Emotional responses
Alteration in Taste & Smell

Atrophy of papillae
Preference of high
sugar & salty foods
Cost
Ability to chew food
Poor oral hygiene
Medications
Altered Olfactory Function

Smell impacted by
lifestyle
Sinus infections
Related to head injury,
CVA, tumors
Affects ability to enjoy
food, environment
Monitoring function
essential for safety