Mosby items and derived items © 2009, 2005 by Mosby, Inc., an affiliate of Elsevier Inc. Chapter 14 Older Adult Denise Coffey MSN, RN

2 Mosby items and derived items © 2009, 2005 by Mosby, Inc., an affiliate of Elsevier Inc. Variability Among Older Adults  Physiological, cognitive, and psychosocial health  Levels of functional ability  Dependence vs. independence  Strengths and abilities

3 Mosby items and derived items © 2009, 2005 by Mosby, Inc., an affiliate of Elsevier Inc. Terminology A. Geriatrics 1. The assessment of health and functional status B. Gerontology 2. The study of all aspects of the aging process and its consequences C. Gerontological nursing 3. Emphasizes nurturing, caring, and comforting more than treatment of disease D. Gerontic nursing 4. Focuses on the diagnosis and treatment of diseases

4 Mosby items and derived items © 2009, 2005 by Mosby, Inc., an affiliate of Elsevier Inc. Myth and Stereotypes  Older adults are:  Ill, disabled, and unattractive  Forgetful, confused, rigid, boring, unfriendly  Unable to learn and understand new information  Not interested in sex or sexual activities

5 Mosby items and derived items © 2009, 2005 by Mosby, Inc., an affiliate of Elsevier Inc. Nurses’ Attitudes Toward Older Adults Nurses need to recognize and address ageism by questioning prevailing negative attitudes and stereotypes and emphasizing what really happens during the aging process.

6 Mosby items and derived items © 2009, 2005 by Mosby, Inc., an affiliate of Elsevier Inc. Theories of Aging  Biological theories  Stochastic or nonstochastic  Psychosocial theories  Disengagement  Activity  Continuity

7 Mosby items and derived items © 2009, 2005 by Mosby, Inc., an affiliate of Elsevier Inc. Developmental Tasks for Older Adults  Linked to the concept of developmental tasks appropriate for stages in life  Loss of health, significant others, socialization, income, independence  Physiological, structural, and functional changes  Redefining relationships

8 Mosby items and derived items © 2009, 2005 by Mosby, Inc., an affiliate of Elsevier Inc. Community-Based and Institutional Health Care Services  Older adults are cared for in:  Private homes, apartments, retirement communities, adult day care centers, assisted living facilities, and nursing centers  Older adults need to help with decisions regarding which type of health care service is appropriate for them.

9 Mosby items and derived items © 2009, 2005 by Mosby, Inc., an affiliate of Elsevier Inc. Assessing the Needs of Older Adults  The interrelation between physical and psychosocial aspects of aging  Effects of disease and disability on functional status  Decreased efficiency of homeostatic mechanisms  Lack of standards for defining health/illness norms  Altered presentation and response to specific disease

10 Mosby items and derived items © 2009, 2005 by Mosby, Inc., an affiliate of Elsevier Inc. Physiological Changes  Older clients’ concept of health revolves around how the perceive their ability to function.  Not all physiological changes are pathological.  Nurses need to be cognizant of normal age-related changes.

11 Mosby items and derived items © 2009, 2005 by Mosby, Inc., an affiliate of Elsevier Inc. Functional Changes  Usually linked to illness or disease and degree of chronicity  The performance of ADLs is a sensitive indicator of health or illness.

12 Mosby items and derived items © 2009, 2005 by Mosby, Inc., an affiliate of Elsevier Inc. Cognitive Changes Delirium Acute confusional state Dementia Generalized impairment of intellectual functioning Depression A mood disturbance characterized by feelings of sadness and despair

13 Mosby items and derived items © 2009, 2005 by Mosby, Inc., an affiliate of Elsevier Inc. Psychosocial Changes  Retirement  Social isolation  Sexuality  Housing and environment  Death

14 Mosby items and derived items © 2009, 2005 by Mosby, Inc., an affiliate of Elsevier Inc. Addressing the Health Concerns of Older Adults  Three common causes of death:  Heart disease  Cancer  Cerebrovascular disease  Other causes include:  Lung disease, accidents, diabetes, kidney and liver disease  All of these conditions have preventive measures.

15 Mosby items and derived items © 2009, 2005 by Mosby, Inc., an affiliate of Elsevier Inc. Health Promotion and Maintenance: Physiological Heart disease CancerStroke Smoking Alcohol abuse Nutrition Dental problems ExerciseArthritis Falls Sensory impairment Medication use

16 Mosby items and derived items © 2009, 2005 by Mosby, Inc., an affiliate of Elsevier Inc. Health Promotion and Maintenance: Psychosocial Health Concerns Therapeutic communication Touch Reality orientation Validation therapy Reminiscence Body image interventions

17 Mosby items and derived items © 2009, 2005 by Mosby, Inc., an affiliate of Elsevier Inc. Older Adults and the Acute Care Setting  Poses risks for adverse events:  Delirium  Dehydration  Malnutrition  Health care–acquired infections  Urinary incontinence  Falls

18 Mosby items and derived items © 2009, 2005 by Mosby, Inc., an affiliate of Elsevier Inc. Older Adults and Restorative Care  Continues the recovery from acute illness  Addresses chronic conditions that affect daily functioning  Aim of care  To regain or improve prior level of independence, ADLs