2Objectives: 1. Identify normal physical changes in the older adult. 2. Discuss nursing Implications due to changes in the older adult.
3The Middle AdultThe years are generally considered to be ages 40 to 65.This is a period of gradual and individualized change in both physical and psychosocial dimensions.Visible signs of aging and a heightened awareness of the time left to live, however, lead middle adults to evaluate their achievement of goals and influence their adaptation to older age.
5Physiologic Development In the early years of this period of life, physical functions are usually still effective.As time passes, gradual internal and external physiologic changes occur.These are not pathologic changes but normal changes that result from aging.The person must modify his or her self-image and self-concept to adapt successfully to and to accept these normal changes.
6Hormonal changesThe hormonal changes that take place in midlife affect men and women differently. Women undergo menopause, a gradual decrease in ovarian function, with subsequent depletion of estrogen and progesterone. This change usually occurs between 40 and 55 years of age.With the cessation of ovulation, menstrual periods stop either gradually or abruptly, and many women experience hot flashes, mood swings, and fatigue.The loss of estrogen also increases the risk for osteoporosis and heart disease. The process can last for several years, and afterward the woman can no longer become pregnant.Men do not experience physical symptoms from the decreased levels of hormones, called andropause.Androgen levels diminish slowly; the man may have some loss of sexual potency but is still capable of reproduction.
7ClimactericA period of life characterized by physiological and psychic change that marks the end of the reproductive capacity of women and terminates with the completion of menopause.A corresponding period sometimes occurring in men that may be marked by a reduction in sexual activity, although fertility is retained.
8Physical Changes in the Middle Adult Fatty tissue is redistributed; men tend to develop abdominal fat, women thicken through the middle.The skin is drier.Wrinkle lines appear on the face.Gray hair appears, and men may lose hair on the head.Cardiac output begins to decrease.Muscle mass, strength, and agility gradually decrease.There is a loss of calcium from bones, especially in perimenopausal women.Fatigue increases.Visual acuity diminishes, especially for near vision (presbyopia).Hearing acuity diminishes, especially for high-pitched sounds.Hormone production decreases, resulting in menopause or andropause.
9Normal Physiologic Changes of Older Adults General StatusProgressively decreasing efficiency of physiologic processes results in a fragile balance and hinders the body's ability to maintain homeostasis.Physical or emotional stressors cause the older adult to be more vulnerable because of decreased physiologic reserves.The older adult may continue to engage in all activities of middle age but intuitively adjusts to a modified pace and more frequent rest periods.
10IntegumentaryWrinkling and sagging of skin occur with decreased skin elasticity; dryness and scaling are common.Balding becomes common in men, and women also experience thinning of hair; hair loses pigmentation.Skin pigmentation and moles are common, although the skin may become pale because of loss of melanocytes.Melanin production decreasesNails typically thicken, becoming brittle and yellowed
12MusculoskeletalDecreases in subcutaneous tissue and weight commonly are found in the old-old.Muscle mass and strength decrease.Bone demineralization occurs, and bones become porous and brittle. Fracture is more common.Joints tend to stiffen and lose flexibility, and range of motion may decrease.Overall mobility commonly slows, and posture tends to stoop. Height decreases slightly.Joints develop degenerative changes
13NeurologicThe central nervous system responds more slowly to multiple stimuli. Hence, the cognitive and behavioral response of the older adult may be delayed.Rate of reflex response decreases.Temperature regulation and pain/pressure perception become less efficient.There may be a loss of sensation in the extremities.The older adult may also experience difficulty with balance, coordination, fine movements, and spatial( space)orientation, resulting in an increased risk for falls.Sleep at night typically shortens, and the older adult may awaken more easily. Cat-naps become common.Short term memory diminished w/o changes in long term memory
14Special SensesDiminished visual acuity (presbyopia) occurs, with increased sensitivity to glare, decreased ability to adjust to darkness, decreased accommodation, decreased depth perception, and decreased color discrimination. Cataracts may further obscure vision. Difficulty reading small print might result. Daytime or night driving might be compromised.Presbyopia – difficulty of seeing objects that are close because of the lens of the eye becomes less pliable.Diminished hearing acuity (presbyacusis) occurs, particularly diminished pitch discrimination in the presence of environmental noises. As a result of hearing problems, the older adult may withdraw from social events.The senses of taste and smell are decreased. Sensitivity to odors might be reduced. Problems with nutrition may result.
15CardiopulmonaryBlood vessels become less elastic and often rigid and tortuous. Venous return becomes less efficient. Fatty plaque deposits continue to occur in the linings of the blood vessels. Lower-extremity edema and cooling may occur, particularly with decreased mobility. Peripheral pulses are not always palpable.The body is less able to increase heart rate and cardiac output with activity.Pulmonary elasticity and ciliary action decrease, so that clearing of the lungs becomes less efficient. Respiratory rate may increase, accompanied by diminished depth.Effectiveness of the cough mechanism lessens increasing risk of lung infectionBrain and coronary arteries receiving more blood than other organs
16GastrointestinalDigestive juices continue to diminish, and nutrient absorption decreases.Malnutrition and anemia become more common.With reduced muscle tone and decreased peristalsis, constipation and indigestion are common complaints.Gag reflex is less effective
17Dentition Tooth decay and loss continue for most older adults. Eating habits may change, particularly if the older adult lacks teeth or has ill-fitting dentures.
18GenitourinaryBlood flow to the kidneys decreases with diminished cardiac output.The number of functioning nephron units decreases by 50%; waste products may be filtered and excreted more slowly.Fluids and electrolytes remain within normal ranges, but the balance is fragile.Bladder capacity decreases by 50%. Voiding becomes more frequent; two or three times a night is usual. A decrease in bladder and sphincter muscle control may result in stress incontinence or incomplete bladder emptying.About 75% of men over 65 years of age experience hypertrophy of the prostate gland; surgery may be required if urinary retention occurs.There is atrophy, decrease of secretions, and thinning of the older woman's genital tract.Major clinical manifestation for UTI – signs of acute confusionFor freq urination - make no changes in the client’s dietary intake and keep the client from self-limiting fluids.
19Reproductive Climacteric Andropause Menopause Risk for breast cancer increasesSperm count and viscosity of seminal fluid decreases
20Cognitive Development The term cognition indicates cerebral functioning, including the ability to perceive and understand one's world.Cognition does not change appreciably with aging. In fact, intelligence increases into the 60s, and learning continues through life.It is normal for an older adult to take longer to respond and react, however, particularly in new or unfamiliar surroundings.Knowing this, the nurse should slow the pace of care and allow older patients extra time to ask questions or complete activities.Mild short-term (recent) memory loss is common but can be remedied by an older adult using notes,
21Adjusting to the Changes of Older Adulthood Older adults use their years of experience as a guide to adjusting to the changes that come with increasing age.These changes, based on Havighurst's tasks for later life, involve many areas of life, as described in the following sections.
22Six Major Stages in human life covering birth to old age. Havighurst identified Infancy & early childhood (Birth till 6 years old)Middle childhood (6-12 years old)Adolescence (13-18 years old)Early Adulthood (19-30 years old)Middle Age (30-60years old)Later maturity (60 years old and over)
23Physical Strength and Health Most older adults gradually modify their lifestyle to accommodate for declining strength and health.They rest more frequently, although continued activity and exercise are important for maintaining all physiologic functions.An older adult is at high risk for accidents and falls and may need to curtail driving or use a cane or other aid to remain mobile.Diet modifications and prescribed medications may be necessary, and because of chronic illness, an older adult may need to adjust to living with some pain.With severe illness, loss of independence can occur.The loss of health is difficult to adjust to because it affects every aspect of life.
24Health of the Older Adult As the number of older adults increases, nurses will spend more time providing care for this population.Older adults who require care are in all types of healthcare settings, including hospitals, long-term care facilities, emergency departments, outpatient surgeries, and homes.Nursing care for older adults should be based on two principles:
25Most older people are not impaired but are functional in the community, thereby benefiting from health-oriented interventions.Older people are more vulnerable to physical, emotional, and socioeconomic problems than people in other age groups and may require special attention to health promotion and maintenance.
26Accidental InjuriesThe older adult is at increased risk for accidental injury because of changes in vision and hearing, loss of mass and strength of muscles, slower reflexes and reaction time, and decreased sensory ability.A significant percentage of older adults limit their activities because of fear of falling that might result in serious health consequences addition, the combined effects of chronic illness and medications may make an older adult more prone to accidents.Older adults with reduced income may live in inadequate housing in neighborhoods with heavy traffic and high crime rates.They may be isolated from family members, and many live alone. Combined with the normal changes of aging and the effects of any illness, older people not only are at increased
27Organic Brain Syndrome Any of various disorders of cognition caused by permanent or temporary brain dysfunction and characterized especially by dementia.Organic brain syndrome (OBS) is a general term, referring to physical disorders (usually not psychiatric disorders) that cause decreased mental function.Acute - sudden confusion or disorientationChronic - long-term, often progressiveDementia – a non specified clinical syndrome characterize by a loss of intellectual functioning
28Dementia, DepressionWhen a serious mental impairment occurs, the effect on the patient and family can be devastating. refers to various organic disorders that progressively affect cognitive functioning. Of the dementias that affect older adults, (AD) is the most common degenerative neurologic illness and the most common cause of cognitive impairment (Stajduk & Shellenberger, 2004).It accounts for about two thirds of cases of dementia in the United States, affecting adults in middle to late life (Arnold, 2004). Scientists estimate that more than 4 million people have AD, and the number of people with AD doubles every 5 years beyond age 65. It affects brain cells and is characterized by patchy areas of the brain that degenerate.Alzheimer's disease is a progressively serious and ultimately fatal disorder. At first, forgetfulness and impaired judgment may be evident. Over a period of several years, the person becomes progressively more confused, forgetting family and becoming disoriented in familiar surroundings.A common problem in patients with dementia is , in which an older adult habitually becomes confused, restless, and agitated after dark. When the ability to perform simple activities of daily living is lost, the person requires constant supervision and care, often in a nursing home. There is no effective medical treatment for AD at this time.Comprehensive and empathetic nursing care is important. Both the patient and family caregivers need emotional support and teaching and may benefit from community resources that can ease the family's burden.
29Nursing intervention for patients with AD Arrange a therapeutic, calm, safe, consistent care environmentNursing intervention for patients with depression- Give client opportunities for making decisions
31Physiologic functionMaintain physiologic reserves. Maintain ongoing assessments for early detection of problems.Review perceptions of current health status, health problems, and prescribed or over-the-counter medications.Include nursing care that maintains physical status, such as skin care and planned rest and activity.Bathe or shower 2 – 3 x a weekOral Care dailyExercise daily to help in regular bmHealthy lifestyle and dse prevention
32Cognitive function Slow pace of activity and wait for responses. Be sure eyeglasses and hearing aids are used; ensure lenses are clean and batteries are strong.Assess cognitive health
33Psychosocial needsBe aware that illness, hospitalization, or changes in living arrangements are major stressors.Assess and support sources of strength, including cultural and spiritual values and rituals.Encourage use of support systems: family, friends, community resources, pets.Set mutual goals and encourage the patient's role in making decisions about care.Encourage life review and reminiscence.Encourage self-care.Consider the patient's background, interests, capabilities, values, culture, and lifestyle when planning care.
34NutritionAssess for lost or damaged teeth; ensure dentures fit properly. Provide foods appropriate to the patient's ability to chew.Assess height, weight, eating patterns, and food choices. If weight is being lost, assess income, storage, and transportation.Assess swallowing ability.Consider using supplements.
35Sleep and rest Discourage excessive napping. Assess normal bedtime, time for rising, bedtime rituals, effects of pain, medications, anxiety, and depression.
36EliminationAssess frequency of bladder elimination as well as problems with incontinence.Assess normal times for bowel movements, changes in activity, privacy, and medications.Ensure that the floor is not cluttered, the toilet is easily accessible, lighting is adequate, and privacy is provided.Suggest having safety bars installed in the bathroom.Review diet for necessary fluid and fiber content.For frequent urination – no change in diet and keep from self limiting fluids
37Activity and exerciseAssess ability to walk; ensure that assistive devices (such as a walker or cane) are available.Consider effects of illness, surgery, medications, and changes in diet and fluid intake on strength and motor function.Ensure an uncluttered environment with good lighting; suggest using a night light and removing throw rugs.Slow the pace of care, allowing extra time to carry out activities.
38SexualityAssist as necessary with hygiene, hair care, oral care, clean clothing and bedding, makeup, and shaving.Maintain a clean, odor-free environment.Demonstrate genuine caring: ask preferred name, listen carefully, respect belongings.Discuss safer sex if appropriate.Discuss water-soluble lubricants with women; refer men for evaluation if erectile dysfunction is a concern.
39Meeting developmental tasks Promote continued development and maintenance of functional health by identifying unmet tasks, feelings of isolation, and physical or sensory limitations.Assist in finding creative solutions to developmental tasks.Collaborate with other healthcare providers to provide information and referral to community resources for the patient and family.
40Health Related Screenings Physical examinationEvery 3 years to age 40Every year from age 40
41Breast cancer (women) Breast self-examination each month Breast clinical examination every 3 years to age 40, then every yearMammogram every year beginning age 40
42Cervical cancer (women) Pelvic examination with Papanicolaou (Pap) exam at least every 3 yearsWomen who have had a total hysterectomy (removal of the uterus and cervix) do not need cervical cancer screening, unless the surgery was for cervical precancer or cancer.Women over age 65 to 70 with at least 3 normal Pap tests and no abnormal Pap tests in the last 10 years should consult with their healthcare provider about continuing cervical cancer screening.
43Prostate (men, beginning age 50) Prostate-specific antigen (PSA) test every yearDigital rectal examination (DRE) every yearBegin at age 45 if African American or a family history of prostate cancer.Screening is individualized based on healthcare provider and individual's concerns.
44Testicular cancer (men) Testicular self-examination every month
45Colorectal cancer (men and women, beginning age 50) Fecal occult blood test every yearDigital rectal examination (DRE) every yearFlexible sigmoidoscopy every 3–5 years, ORColonoscopy with follow-up every 3–5 years depending on size of polyps
46Skin cancer (men and women) Self-examination every monthClinical skin examination every year
47Oral cancer (men and women) Every year as part of medical or dental checkups
48Bone densityThose at risk: postmenopausal women, maternal history of hip fracture, fracture after age 50, tall height at age 25Maintain a calcium intake of – 1500 mg daily
49VisionEye examination, with a test for glaucoma, every year
50Immunizations Tetanus, diphtheria (Td): 1-dose booster every 10 years Influenza: 1 dose every yearPneumococcal polysaccharide vaccine (PPV): 1 dose every year up to age 64 for those with medical indications; 1 dose for those unvaccinated by age 65, or who received the first dose more than 5 years previously (before age 65)
51Role of the Nurse in Promoting Health and Preventing Illness Risk for Imbalanced Nutrition: More ThanBody RequirementsHigh calorie diet and sedentary lifestyleConstipationDiet low in fiber and lack of exerciseRisk for Impaired Skin Integrity dtLifetime of sun exposure
52Sedentary LifestyleLack of resources (time, money, facilities)
53Medicare Available for older adults May qualify for home health care requiring skilled personnel.