1. Chapter 33 Health Promotion and Care of the Older Adult
Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc.

2. Overview of Health and Wellness in the Aging Adult
Older Adulthood Defined
Older adulthood begins at about age 65 and continues until death, which can cover a span of 40 years or more.
Young-old: ages 55 to 74 years
Old-old: 75 years old and older
Frail elder: over 75 years old with health concerns
Centenarians: older than 100 years
Chronological age is a very poor indicator of old age.
Some individuals are “old” in their 50s, and others in their 90s are physically and mentally active.
Give examples of experiences in which you have witnessed individuals who appear older or younger than their chronological age.

3. Overview of Health and Wellness in the Aging Adult
Demographics
In the United States in 1990, over 12% of the population was older 65 years.
During the past two decades, the older adult population has grown twice as fast as the rest of the population.
It is projected that by the year 2030, over 21% of the population will be older than 65.
Approximately 60% are women and 40% are men.
The majority are white (90.5%); African-Americans and other races make up 9.5% of older adults.
Why will there be more older adults in the year 2030? Baby boomers are hitting older adulthood
Why do you think people are living longer? Preventative tests, technology, education

4. Overview of Health and Wellness in the Aging Adult
Demographics (continued)
The health care delivery system is becoming more complex for several reasons.
Scientific advances more often delay life-threatening conditions of the past.
Life expectancy has substantially increased.
More focus has been placed on ethical and legal issues related to life, disease, research, and dying.
Give examples of scientific advancements that have contributed to increased longevity.
How has an increased focus on ethical and legal issues influenced longevity?

5. Overview of Health and Wellness in the Aging Adult
Wellness, Health Promotion, and Disease Prevention
A strong emergence of the holistic movement is changing the perception of health from the absence of disease to a broader definition of wellness.
Wellness is based on a belief that each person has an optimal level of function and that even in chronic illness and dying some level of well-being is attainable.
What does the term “holistic” mean?
Give an example of how wellness can be displayed in the person who is dying.
Discuss wellness continuum-is ever changing-goal is to get to and maintain optimum level of wellness

6. Health Promotion for Healthy Aging
Keeping healthy, active, and moving will require a high standard of assessment and health promotion.
Healthy People 2000 set forth the goals of the U.S. Department of Health and Human Services to prevent health risks, unnecessary disease, disability, and death. These recommendations have been updated in Healthy People 2010.
The intent of these goals focuses on improving functional independence and the quality of life.
Traits of a healthy person-self responsibility(knows body, knows diagnosis, takes actions to maintain/fix health status), nutritional awareness, physical fitness, stress management, environmental sensitivity(balance work and social, etc)
Health Promotion is a nurses responsibility-prevention becoming more of a priority
Healthy People –edamples of goals-Reduce heart attacks, strokes, osteoporosis

7. Overview of Health and Wellness in the Aging Adult
Myths and Realities
The myths and stereotypes of aging and older adults are numerous.
Most myths are generalizations that focus on the negative aspects of aging.
In many cases, research has proven such myths to be inaccurate.
Give examples of negative effects of aging that are myths. (Old people are senile, isolated, alone, in nursing homes, poor, ill and disabled)
Give a stereotype about aging.
Define ageism-prejudice against older adults

8. Overview of Health and Wellness in the Aging Adult
Theories of Aging
Our current knowledge about aging and the aging process is very limited.
Biological theories attempt to explain why the body ages.
Psychosocial theories try to give reasons for the responses and interactions older adults have with society during late adulthood.
Why do you think our knowledge regarding aging is limited?
Why do you think older adults receive negative responses from our society?
Why do we age? Programmed aging (cells have “lifespan”), genetic factors, Immune system wers out over time, free radicals destroy cells in body, wear and tear

9. Overview of Health and Wellness in the Aging Adult
Legislation Affecting Older Adults
Social Security Act of 1935
This was the first major legislation that attempted to provide financial security for older adults.
Older Americans Act
Objectives were to preserve the rights and dignity of our nation’s older citizens.
National Family Caregiver Support Program
Program provides a means of addressing the nation’s growing needs of caregivers.
Why did the government have to institute the Social Security Act to protect the financial security of older adults?
Why does our country need to address the needs of caregivers?

10. Psychosocial Care of the Older Adult
Loss, Grief, and Depression
Significant psychosocial changes experienced by the older adults may include personal, social, and economic losses.
There are changes in roles and retirement and the loss of significant others.
Physical changes can result in losses of independence and space.
Some older adults have successful coping strategies for grief or isolation; for others, the stress and grief lead to either short- or long-term depression.

11. The Aging Body Integumentary System Age-related changes
Lack of pigment in hair (graying)
Thinning hair and baldness
Less collagen and elasticity in the skin, with less fat under the skin (wrinkles)
Age spots (lentigo)
Thinning of the epidermis and reduced numbers of oil and sweat glands
Increased fragility of blood vessels, resulting in ecchymosis
How does less fat under the skin contribute to wrinkles? Also d/t less skin elasticity
What are age spots? Buildup melanin
Skin heals more slowly
What is ecchymosis?
What could be the health significance of a reduced number of sweat glands?

12. The Aging Body Integumentary System (continued) Assessment
Observe skin for signs of excessive dryness or openings in the skin.
Observe hair for excessive loss, dryness, or oiliness.
Observe the nails for excessive length, sharp edges, brittleness, increased thickening, and yellowing.
Why should the nurse assess for hair loss? Can be endocrine issue (hypothroidism)

13. The Aging Body Integumentary System (continued)
Common concerns and nursing interventions
Pruritus
Due to reduced glandular secretions and moisture
Pressure ulcers
Thin skin and lack of subcutaneous fat predispose the older adults to pressure ulcers when fragile skin is compressed between bony prominences of the body.
Shearing forces may produce injury via a shearing strain.
Interventions-decrease bathing to decrease dryness. Lotions may be needed. Avoid antibacterial soaps.
May get increased numbers of moles. Should check if change in size, color, border
Nails-clubbing ( no O2), yellowing (fungal infection), Splintering(malnutrition)
Interventions for pressure ulcers-turn every 2 hours, elevate heels, skin assessment, other ideas?
If incontinent clean frequently, no wrinkles in sheets, watch using tape, nutritional needs (protein, fluids)

14. The Aging Body Gastrointestinal System Age-related changes
Decreased secretion of saliva and enzymes in the intestinal tract
Atrophy and decreased tone of the intestine
Decreased peristalsis
Changes may be intensified by medications, lack of fluids or dietary roughage, and lack of exercise.
Decreased peristalsis-constipation
Decrease taste and appetite
Decreased production intrinsic factor-B12 deficiency, pernicious anemia

15. The Aging Body Gastrointestinal System (continued) Assessment
Assess oral cavity for lesions, dental caries, loose teeth, and halitosis.
Assess ability to chew and swallow.
Assess for complaints of intestinal cramping.
Assess dietary intake and weight.
Assess for signs of abdominal distention.
Assess bowel elimination and use of laxatives.
Assess individual’s ability to control defecation.
Assess bowel elimination routes.
Why should the nurse assess the oral cavity?
What concerns might the nurse have regarding dietary intake and the patient’s weight?
What is normal concerning BM routines?

16. The Aging Body Gastrointestinal System (continued)
Common concerns and nursing interventions
Obesity
Less food is consumed than in their earlier, more physically active years.
Weight loss
Gradual weight loss is normal; rapid weight loss may indicate illness and should be reported.
Fluids/dehydration
Have fluids available and toilet facilities easily accessible.
What illness might the nurse suspect for the older patient who experiences a rapid weight loss? Cancer, diabetes, absorption disorders
Define obesity-weighing 20% more than ideal body weight.

17. The Aging Body Gastrointestinal System (continued)
Common concerns and nursing interventions (continued)
Oral hygiene
Thorough cleansing of the entire mouth structure should be done with a soft-bristled toothbrush in the morning and at bedtime.
Loss of appetite
Prepare food using color and garnishes, attractive dishes, and table setting with good lighting and bright colors.
Dentures or partials- do they fit, are they wearing them?
Last tastes to go are sweet and salty. May add lots of salt (bad for B/P), want only sweets
Assistive devices-large handled utensils, cups with nose cut out, plates with rims,

18. The Aging Body Gastrointestinal System (continued)
Common concerns and nursing interventions (continued)
Gastric reflux
Encourage small meals, no eating before bedtime, and elevation of the head of the bed.
Food intolerance
Lactose intolerance is common. Replace milk with cheese and yogurt.
Describe how small meals help the person with gastric reflux.
Why should the head of the bed be elevated?

19. The Aging Body Gastrointestinal System (continued)
Common concerns and nursing interventions (continued)
Dysphagia
Add thickeners to liquids; provide upright positioning, with leaning slightly forward with the chin down; reduce distractions.
Constipation
Ensure adequate fluid, exercise, and a diet that contains fiber.
What is dysphagia?
How does thickening liquids assist the individual with dysphagia?
How do increased fluids, exercise, and fiber help with constipation?
Chin tuck then swallow. Bite then drink. Watch pocketing of food.
Nursing diagnosis-Impaired swallowing related to _____________________-
Imbalance nutrition: less than body requirementsr/t________________________

20. The Aging Body Urinary System Age-related changes Assessment
Overall, kidney function and bladder capacity decrease with age.
The bladder and sphincters lose elasticity and are less responsive to stimulus to urinate.
Men commonly experience enlargement of the prostate.
Assessment
Assess frequency, amount, odor, and consistency of urine.
Assess individual’s ability to control urination.
Less nephrons=less urine
Incontinence can develop
Increased UTI

21. The Aging Body Urinary System (continued)
Common concerns and nursing interventions
Nocturia
Encourage patient to limit fluids in the evening, to take diuretic medications in the morning, and to minimize the hazards for falls.
Incontinence
Provide frequent and easy access to a bathroom or a urinal or commode.
Client is ordered Lasix daily. When do we give it? Why?
Types of incontinence-stress(cough, sneeze, strain), urge(have to go NOW, may pee self), overflow-full bladder cannot empty, small amounts released, functional-inability or unwillingness to toilset (immobility, depression, depend on caregiver)
Interventions-encourage fluids, commode near, toileting schedules, depends, kegel exercises
Nursing diagnosis-Functional urinary incontinence

22. The Aging Body Cardiovascular System Age-related changes
Changes involve loss of structural elasticity.
It takes longer for the heart to contract and the chambers to fill.
Heart valves become thicker and more rigid.
There is a decrease in pacemaker cells, and the electrical conduction is slowed.
Resting heart rate may decrease.
Arteriosclerosis develops, which increases blood pressure.
Heart not as effective-does not pump as much with each beat, some blood remains in heart(risk for CHF)
Risk for MI, stroke, hypertension

23. The Aging Body Cardiovascular System (continued) Assessment
Assess for signs of pallor, rubor, or cyanosis.
Assess and compare apical and peripheral pulses.
Assess capillary refill time.
Assess for presence of vertigo or syncope.
Assess blood pressure in lying, sitting, and standing positions.
Assess for edema.
Why would the nurse assess apical and radial pulses?
What is the difference between vertigo and syncope?
Why should the blood pressure be checked lying, sitting, and standing?
What is the significance of edema? Right sided heart failure
Decreased pedal pulses-PVD, PAD

24. The Aging Body Cardiovascular System (continued)
Common concerns and nursing interventions
Dysrhythmias
Check vital signs frequently.
Monitor fluid I&O.
Observe and report the older adult’s response to medications.
Monitor the response to activity, and provide rest periods before and after activity.
Why is it important to assess I&O?
Give examples of what responses the nurse should observe regarding medications. (lasix decreases K-can affect heart)

25. The Aging Body Cardiovascular System (continued)
Common concerns and nursing interventions (continued)
Peripheral vascular disease
Encourage walking to stimulate venous return.
Discourage standing in one place for long periods.
Discourage crossing legs or knotting stockings to hold them up.
How does walking stimulate venous return?
Why does standing in one place cause cardiovascular problems?
What is the risk of crossing the legs?
Interventions-check peripheral pulses, avoid constricting clothes, ambulate, heel pumps
Nursing diagnosis-Decreased cardiac output, Ineffective tissue perfusion

26. The Aging Body Respiratory System Age-related changes
Tissues of lungs and bronchi become less elastic and more rigid with age.
The chest wall is less able to expand because of changes in the skeletal system.
Muscles associated with respiration are weakened, so that lung expansion and vital capacity are decreased.
Overall, the older person’s air exchange is reduced, and secretions remain in the lungs.
Barrell chest, decreased cilia, less O2 taken in and exchanged with each breath
Diagnosis-ineffective airway clearance.
Activity intolerance

27. The Aging Body Respiratory System (continued) Assessment
Assess depth, rhythm, and rate of respiration at rest and with activity.
Assess the amount of activity the individual is able to tolerate.
Assess for the presence of cough, productive or nonproductive.
Describe how the nurse would assess depth.
How does activity relate to the respiratory system?
Cyanosis? O2 saturation?

28. The Aging Body Respiratory System (continued)
Common concerns and nursing interventions
Chronic obstructive pulmonary disease (COPD)
Encourage adequate intake of fluids.
Avoid smoking and air pollution.
Avoid crowds and people with upper respiratory infections.
Ensure adult receives annual influenza vaccine.
Why should the nurse encourage fluids for this patient?
Why should this population receive an annual flu vaccination?
COPD tend to retain CO2, have diminished breath sounds, wheezing, crackles, SOB with exertion
Interventions-pursed lip breathing, meds (bronchodilator)chest PT, O2 if ordered, stop smoking

29. The Aging Body Respiratory System (continued)
Common concerns and nursing interventions (continued)
Pneumonia
Liquefy secretions through adequate intake of fluids and prescribed medications.
Assist with removal of secretions by teaching proper coughing technique to improve airway clearance.
Promote turning, coughing, and deep breathing to improve gas exchange.
CXR, antibiotics, O2, bronchodilators, fluids, cough and deep breath

30. The Aging Body Musculoskeletal System Age-related changes
There is a reduction in the number and size of active muscle fibers with decreased muscle strength.
Joints become less elastic and flexible with the loss and calcification of cartilage.
Demineralization of bone leads to osteoporosis.
Changes in the spine bone structure and compression of intravertebral discs result in postural changes such as kyphosis.
Osteopoarosis= fracture
Arthritis-osteoarthritis-wear and tear on joints-pain, inflammation-NSAIDS, antiinfammatories
Nursing diagnosis-Impaired mobility-use assistive aides such as raised toilet seats, reachers, braces, canes walkers

31. Kyphosis-decreases lungs ability to expand

34. The Aging Body Musculoskeletal System (continued) Assessment
Assess ability to stand, move, and perform ADLs.
Assess gait, including balance, posture, base of support, size of steps, and ability to turn.
Assess for muscle weakness, paralysis, joint edema, pain, or limitations in joint mobility.
How would the nurse assess muscle weakness and paralysis?
Describe a limitation of joint mobility.

35. The Aging Body Musculoskeletal System (continued)
Common concerns and nursing interventions
Arthritis
Relief of stress on affected joints through the use of rest and assertive devices such as splints, walkers, adapted utensils, and use of clothes with Velcro fasteners
Range-of-motion and other forms of mild exercise
Heat and gentle massage
Give examples of mild forms of exercise.

36. Rheumatoid arthritis
What types of things would be difficult for this person to do?

38. The Aging Body Musculoskeletal System (continued)
Common concerns and nursing interventions (continued)
Falls
Maintain an environment that is free of hazards.
Increase lighting for decreased vision.
Provide assistive devices such as walkers and canes to aid with balance.
Teach to sit on the side of bed when arising and to stand for several minutes before walking.
Encourage exercises that increase strength, balance, endurance, and body awareness.
Give examples of what could potentially cause a fall in the home.
Why should the older adult be instructed to stand for a few minutes prior to walking?
How does exercise help this population?
Risk for falls-call light, non-skid slippers, bed low, watch after meds, ortho B/P

39. Hip fractures-ABDUCTION, BUCKS TRACTION (weights to maintain in position until surgery), Signs-rotated foot on affected side, shorter leg affected side

42. Hip abduction pillow

43. The Aging Body Musculoskeletal System (continued)
Common concerns and nursing interventions (continued)
Osteoporosis
Prevention begins with children and adolescents
Diet high in calcium and vitamin D
Regular weight-bearing exercise
Hormone replacement therapy
Calcium supplements
Why should the prevention of osteoporosis begin with children and adolescents?
Why should an individual include vitamin D in the diet? Need sunlight to create naturally
Why are hormone replacements useful in this condition? Think parathyroid hormones

45. The Aging Body Endocrine System Age-related changes Assessment
The levels of hormones secreted and the response of body tissue to hormones change with age.
Assessment
Assess laboratory results and report abnormal calcium, glucose, or thyroid hormone levels.
Calcitonin, parathyroid hormones
Diabetes Type 2-insulin resistance

46. The Aging Body Endocrine System (continued)
Common concerns and nursing interventions
Noninsulin-dependent diabetes mellitus
Goal is to achieve and maintain a normal metabolic state through diet management, weight control, and exercise.
Intake should be balanced with recommended amounts of protein, carbohydrates, fats, vitamins, and minerals; refined sugar is limited; high-fiber diet is encouraged.
Monitor glucose levels, good foot care, and safety precautions.
Describe a normal metabolic state.
Why is foot care such a concern for the individual with diabetes mellitus?
Polyphagia, Polydipsia, Polyuria
Sliding scale, sugar screens ac/hs with sliding scale

47. The Aging Body Endocrine System (continued)
Common concerns and nursing interventions (continued)
Hypothyroidism
Assess for weight gain, dry skin, thinning of hair, cold intolerance, delirium, and depression.
The goal for interventions is stabilization of thyroid levels with medication (levothyroxine).
Describe the pathophysiology regarding weight gain and hypothyroidism.
Other symptoms: constipation, fatigue, bradycardia, low B/P

48. Hypothyroidism

49. The Aging Body Reproductive System Age-related changes Assessment
There are diminished levels of male and female hormones.
There is diminished sexual function.
Menopause in women decreases vaginal secretions and the pH becomes more alkaline.
Assessment
Assess for signs of vaginal or penile ulceration, edema, or discharge.
Assess for the presence of dimpling or drainage from the breast.
Menopause-starts 40’s-end of ovulation and menstrual cycle_ends when no period for 1 full year. Causes decrease in estrogen-increases risk heart disease, stroke. HOT FLASHES associated with sudden drop in estrogen.
Men can father children until death as long as they can achieve and maintain erection

50. The Aging Body Reproductive System (continued)
Common concerns and nursing interventions
Sexual function
Estrogen creams or water-soluble lubricants are used for vaginal dryness.
Encourage and help older adults to look their best, complimenting them when they look nice.
Respect older adults and allow them to have their privacy.
Why should the nurse compliment older adults on their looks?
Why is privacy a concern?
What medications can be used to treat impotence in the aging male, and what are the nursing implications related to these medications? Viagra, Cialis
As long as competent, not our business
BPH concern in men-Benign prostatic Hypertrophy-prostate tissue enlarges-can cut off urine flow-get urgency, retention, dribbling (overflow incontinence, urge incontinence

51. The Aging Body Sensory Perception Age-related changes
Visual impairment
Cataracts, glaucoma, macular degeneration, and diabetic retinopathy
Presbyopia, narrowing of the peripheral field of vision, decreased ability to focus on near objects, and decrease in visual acuity
Depth perception distorted and vision in dim light difficult
Describe clinical manifestations of macular degeneration.
What is diabetic retinopathy?
Presbyopia-starts in 40’s-bifocals, adjust where hold reading materials

52. Air test-increased fluid in the eye-increased intraocular pressure
Cataracts-whitish haze over len of the eye

53. Acute closed angle glaucoma

55. Cataract Cataract-safety issues. Glasses at hand, move obstacles.
Setting up tray (face of clock)

57. The Aging Body Sensory Perception (continued)
Age-related changes (continued)
Hearing impairment
Presbycusis: the normal loss of hearing acuity, speech intelligibility, auditory threshold, and pitch associated with aging
Touch and position
Decreased number of receptor cells in the skin and joints
Difficulty sensing temperature and maintaining balance

58. The Aging Body Sensory Perception (continued) Assessment
Assess eyes for dryness, tearing, or signs of irritation.
Assess ability to see both close up and at a distance.
Assess hearing; note the use of hearing aids.
Assess for reported changes in taste or smell.
Describe signs of irritation.
How would the nurse assess near and far vision?
Hearing aids-store with batteries out, place every day. Check for earwax that can block ear canal.

59. The Aging Body Sensory Perception (continued)
Common concerns and nursing interventions
Decreased vision
Ensure that the patient’s eyeglasses are clean and are available.
Increase the amount of light in the environment.
Reduce glare by use of shades on windows and lights.
Use night lights to avoid abrupt light-to-dark changes.
Why should the light be increased?

60. The Aging Body Sensory Perception (continued)
Common concerns and nursing interventions (continued)
Decreased hearing
Hearing aids
Face the individual and speak at a normal or slightly slower pace without exaggerating or shouting.
Nonverbal communication: gestures, smiles, nodding, and written communication
Why does facing the patient assist with the ability to hear?
Describe how nonverbal communication helps the older adult.

61. The Aging Body Sensory Perception (continued)
Common concerns and nursing interventions (continued)
Peripheral neuropathy
Teaching the need for careful daily inspection for blisters, cuts, or infections.
Avoid smoking, constricting footwear, and crossing of legs.
Why should constricting footwear be avoided?
Why should the nurse teach these patients to inspect for cuts, blisters, or infections?
How does smoking aggravate peripheral neuropathy? Nicotine vasoconstrictor

62. The Aging Body Nervous System Age-related changes
There is a decline in the number of peripheral nerve cells and fibers, as well as brain cells.
Nerve impulse transmission in the nervous system slows, resulting in slower reaction time.
Autonomic nervous system changes include decreased efficiency in maintaining normal body temperature and in the pulse returning to normal after exercise or stress.
Senility and dementia ARE NOT part of the normal aging process

63. The Aging Body Nervous System (continued) Assessment
Assess alertness level.
Assess appropriateness of behavior and responses.
Assess changes in memory.
Assess for the presence of pain.
Assess sleep patterns.
Why would the nurse assess appropriate behavior and responses?
How would the nurse assess pain?
Often sleep less-especiall y women after menopause. May shift to stay up late, sleep more during the day

64. The Aging Body Nervous System (continued)
Common concerns and nursing interventions
Insomnia
Encourage a bedtime ritual.
Exercise and activity during the day increase the likelihood of falling asleep at night.
Encourage a nap in the morning rather than in the afternoon.
How does a bedtime ritual help an older adult?
Why should this population nap in the morning instead of the afternoon?

65. The Aging Body Nervous System (continued)
Common concerns and nursing interventions (continued)
Delirium
Reality orientation
Call patient by his or her correct name.
Make eye contact; be honest.
Converse about familiar subjects.
Provide familiar objects in the environment.
Explain events and procedures in concise, simple language.
Set a routine and be consistent.
Give an example of how the nurse might assess for delirium and depression.
A&O times 3 or 4

66. The Aging Body Nervous System (continued)
Common concerns and nursing interventions (continued)
Dementia/Alzheimer’s disease
Goals are to maintain maximum self-care abilities and to prevent injury.
Divide ADLs into small steps and explain as they are done in very specific and simple terms.
Maintain a calm, distraction-free environment.
Monitor for wandering.
Institute interventions to prevent injury.
Routine is very important; any changes should be introduced very slowly.
Give examples of methods to prevent injury.
Why is routine important?

67. Causes decrease in grey matter of the brain-CT or MRI

69. The Aging Body Nervous System (continued)
Common concerns and nursing interventions (continued)
Parkinson’s disease
Observe response to medications.
Maintain mobility through exercise and activity.
Provide range-of-motion exercises and massage.
Provide a safe environment.
Encourage use of mobility aids.
Give individual time to respond, encourage efforts to communicate, and show acceptance.
Why is mobility important for this disease?
Why does this individual need time to respond?
Why is communication an issue?
Caused by decrease in dopamine a neurotransmitter resposible for smooth coordinated movement. Treat with dopamine replacements
See shuffling gait, hard to start/stop, not lifting feet. Tremors. Decreased response time

71. The Aging Body Nervous System (continued)
Common concerns and nursing interventions (continued)
Stroke
Goals focus on rehabilitation to maximize the ability to accomplish ADLs and to be as independent as possible.
Encourage or assist patient to do exercises and activities prescribed by the therapist.
Communication techniques for aphasia include listening carefully, using pictures and appropriate gestures, speaking slowly, using direct short statements, and not interrupting.
Give examples of communicating with the aphasic individual.
Two types of stroke-occlusive, hemorrhagic
TPA-dangers
Wernicke, Brocas areas-speech and language understanding
Symptoms? Drooping, asymmetric facial features, confusion, one side weakness
Early treatment essential-first 3 hours can often get all function back
Neuro checks, complications of immobility, swallowing difficulties,

72. This is hemorrhagic stroke- would NOT treat with TPA-why??

74. Psychosocial Care of the Older Adult
Cognitive Changes
Aging has little influence on cognition.
Only some older people experience some cognitive deficits.
Research indicates that most older people retain their intelligence and are capable of learning throughout their lives.
How can this population apply its cognitive abilities within the community?
Some cultures revere their elderly-USA is not one of these/

75. Health Care and the Aging Adult
Illness Responses
Frequently, older adults respond to illness by developing disorientation or delirium, weakness, immobility, incontinence, or by falling.
The development of such changes in behavior should be recognized, documented, and reported; they may indicate treatable infection or illness before the typical signs and symptoms are seen.
Describe the pathophysiology that causes the older adult to respond to illness in this manner.

76. Security Concerns for the Older Adult
Finances
Health care can become a major expense and devastate the older adult’s personal financial security.
Many have a fixed income from retirement pensions and only limited savings to pay for the rising costs of housing, food, and health care.
Financial problems can arise when people have not planned carefully for retirement; retirement planning should begin early in life for both men and women.
What resources are available for the older adult regarding housing, food, and health care? Social security., Medicare

77. Security Concerns for the Older Adult
Housing
The majority of older adults prefer to remain independent and have their own, noninstitutionalized housing.
Other options for living arrangements might include retirement villages or senior housing apartments or single-family homes.
What type of housing is available in our community?

78. Health Care and the Aging Adult
Medications
Minimizing adverse effects and drug interactions can be a delicate balancing act.
Age-related changes in body function can contribute to adverse reactions.
Metabolism of medications is decreased as a result of decreased blood flow to the liver, fewer functioning liver cells, and a decrease in the liver enzymes.
Dosages may need to be reduced to prevent toxicity.
Older adults-metabolize and excrete meds more slowly-increase risk toxicity
May need to get smaller doses further apart.

79. Overview of Health and Wellness in the Aging Adult
Elder Abuse and Neglect
Violence toward individuals over the age of 65
Classifications of abuse
Physical or sexual abuse
Psychologic abuse
Misuse of assets
Medical abuse
Neglect
Indicators of elder abuse
Frequent unexplained crying; unexplained fear of or suspicion of a particular person
Give examples of psychological abuse and medical abuse.
Required by law to turn in.

80. Health Care and the Aging Adult
Hospitalization, Surgery, and Rehabilitation
Older adults have less reserve to cope physically and emotionally with the effects of hospitalization and surgical interventions.
They require longer postoperative recovery and convalescent periods.
Minimize the normal effects of immobility: stasis of secretions, orthostatic hypotension, and digestive and perceptual disorders.
Encourage to perform self-care activities at older adult’s own level of tolerance and to have rest periods.
Preop-teach incentive spirometry, breathing techniques
Post op- movement, cough and deep breathing exercises, high protein, SCD, safety with pain meds