Care of Older Adults P & A

Delirium
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Terms in this set (69)
Delirium
is a temporary state of acute confusion. Hyperalert, restlessness, agitation, misperception, hallucinations.
Often first sign of infecting
Image: Delirium
Dementia
Chronic irreversible confusion, is rooted in organic brain changes and rarely has a sudden onset. AD is the most common type
4 most frequently occurring medical conditions
hypertension (72%)
arthritis (50%)
heart disease (30%)
cancer (24%),
diabetes (20%)
Risk for Delirium
advanced age and preexisting cognitive impairment are the most common, medication, trauma, infection, immobility, electrolyte imbalance, cerebral anoxia, hypoglycemia, drug interactions, poor nutrition.
Image: Risk for Delirium
Environmental factors Delirium
Sensory deprivation/overload (ICU Psychosis)
Unfamiliar surrounding
Sleep deprivation
Decreased immune defense
As people age, their immune system becomes less efficient. Their humoral immunity declines due to diminished T-cell function, and older adults have lower antibody response following respiratory infections to fight off pneumonia
Young old
65-74
Old
75-84
Old old
85+
Ego vs Despair
Erik Erikson identified the critical conflict at this point in life . This involves reflecting on one's life and either moving into feeling satisfied and happy with one's life or feeling a deep sense of regret. Success in this can lead to wisdom
WisdomEnables a person to look back on their life with a sense of closure and completeness, and accept death without fearValidation therapyinvolves accepting the description of the time and place as stated by the confused person. You go along with it. In patients in late stages of AD or experiencing dementia, or delirium, this helps reduce agitationPresbyopiaA gradual, age-related loss of the eyes' ability to focus actively on nearby objectsPresbycusisis the most common type of Sensorineural Hearing Loss caused by the natural aging of the auditory system. It occurs gradually and initially affects the ability to hear higher pitched (higher frequency) sounds.Change in cerumenBecause there is a decrease in the sebaceous gland function, the ear wax becomes very dry and may become "packed" in the ear canalDecrease in ProprioceptionThe ability to know where our bodies are in time and space, this leads to a decreased sense of balance and coordinationIncontinence, is it normal?It is not a normal part of aging, so pt should seek medical interventions. It it more common in womenS & S of Acute IllnessConfusion, falls, dehydration, decreased appetite, decreased of function of ADLs, dizziness and incontinenceNormal memory loss?Mild short term memory, like forgetting where keys or wallet is, is considered a normal part of agingALtered Cognitive Function SignsCognitive/thinking impairment Disorientation Poor Judgment Loss of Language skillsFolsteins Mini-Mental State Exammost commonly used tool Clock drawing testWarning Signs of the onset of AD (8)Memory Loss, Difficulty with complex mental tasks, Disorientation, Apraxia, Lack of Judgment, Loss of language, Misplacing Things, Changes in Mood/personalityApraxiais a motor disorder caused by damage to the brain, in which the individual has difficulty with the motor planning to perform tasks or movements when asked. They struggle to complete familiar actions, like brushing teeth or hearDisorientationConfusion about time and place, they may forget where they are, forget why they are somewhere or what they are doingMisplacing thingsin very odd places, like a phone in the fridgeChanges In Mood, ADRapid mood changes, from calm, to tears, to anger. Personality changes, suspicious, fearful withdrawn, becoming passiveNumbers of ADAccounts for 60-80 % of all Dementia pt 75+ is about 20% of populationEarly progression in ADEarly- short term loss that is apparent to close relatives, losing or misplacing things, decreases ability to planMid progression in ADMid- personality changes, unable to recall important info (like their phone number or address), but memory of self and family remains, disorientation and confusionLate Progression in ADMay recall own name but unable to recall personal history, loss of awareness of surroundings, unrecognizable speech, incontinence, inability to eat without assistance or impaired swallowingVascular Dementiacaused by trauma or circulatory problemsMain traits of ADProgressive and irreversible Usually 7 years after diagnosis Memory Loss Problems with Judgement Change in personalityCholinesterase inhibitorsUsed mild to moderate dementia Blocks cholinesterase, an enzyme that breaks down acetylcholine. Helps stabilize cognitive decline but does not cure itAcetylcholineis an organic chemical that functions in the brain and body of many types of animals, including humans, as a neurotransmitter—a chemical released by nerve cells to send signals to other cellsEffects of Cholinesterase inhibitors-Acetylcholine is able to hang around longer and enables transmission neural impulses -Pt do not improve, however their symptoms may plateau -A slowing of symptoms NOT A CUREAriceptTrade name for Donepezil hydrochloride A Cholinesterase inhibitor s/e nausea, diarrhea, sleep disturbanceNamendaTrade name for Memantine A treatment for AD Protects nerve cells amounts of glutamate Stabilizes deteriorationEffects of Glutamateexcess amounts contribute to the death of brain cells in pt with ADGoal of nursing interventions of AD-Decrease clinical manifestations -Prevent harm -Support pt and familyNursing intervention of AD-Maintain routines -Use short directions -Avoid Arguing -Calm/low voice -Ensure Safety -Repeat explanations -Label fourniture -Offer snacks/light meals if unable to sit for long -Initiate bowel/bladder programsSundowningNocturnal delirium. Confusion/agitation that increases within 1 hour of night *Occurs most freq. with pt that are significantly cognitively impairedNursing Intervention Delirium-Protect pt from harm -Create safe and quite env't ( noise/lighting) -Encourage family to stay bedside -Support family and caregivers -Treat underlying cause (if infection, treat with antibiotics)Nutritional needsThere is a decrease in calorie requirement However, minerals, vitamins and protein intake should remain the sameWhat is the NIA?National institute On AgingMedication ToxicityOlder adults are at higher risk of r/t Decreased lean body mass Decreased glomerular filtration rate AEB to an excessive accumulation of the medication in the bodyWhat percentage of the eldery living on their own consume fewer than 1,000 calories per day?16% Due to various factors of people 75 years or older, an estimated 40% of men and 30% of women are at least 10% underweight.The patient receives a score of 12 on the Braden scale. What is the risk for impaired skin integrity for this patient?A score of 15-16 indicates a low risk, 13-14 indicates a moderate risk, and a score of 12 or less is indicative of a high risk for pressure ulcer development.. How many elderly in the United States are estimated to be mistreated every year?As of 2008 it was estimated that 700,000 to 1.2 million elderly adults were the victims of physical, sexual, psychological, or financial mistreatment or neglect.Which group of individuals in the elderly population are most likely to be widowed, female or male, and at what age?Women 75+ In 2008, almost half of women (42%) were widowed by age 65, compared with 14% of men. Of women 75 years or older, only 28.9% lived with a spouseWhat groups of adult populations are most likely to have undertreated pain?-85 years or older, -those of a minority race, - those with low cognitive performance. Studies indicate that an estimated 80% of nursing home residents have substantial, often unrecognized, and undertreated pain.Typical change in the sleep cycle-an increase in stage I and a decrease in deep sleep. These changes lead to a less restful sleep and more frequent awakenings during the nightFactors contributing to weight loss in older adult populations-decreased thirst and smell, -alterations in taste, -early satiation (feeling full) -anorexia. - decline in physical activity that further limits the intake of essential micronutrients.Strategies to try before antipsychotic are used...behavioral, environmental, and social strategies should be attempted to help improve cognitionElderly are at risk for infection r/tHumoral immunity declines because of changes in T-cell function, and older adults have lower antibody response to microorganisms that cause pneumonia and infectionthe largest growing population of individuals over 65 years in both the United States and Canada is?85 years and older In 2002, the number of people 65 to 74 years was eight times larger than in 1900, the number of people 75 to 84 years was more than 16 times larger, and the number of people 85 years or older was 38 times larger.Total older adult populaitonThe older population - persons 65 or older - represent 13.7 % of the US population in 2012Constipation is more common and may be related to (5)decreased peristalsis from loss of abdominal muscle tone, inadequate fluid and fiber intake, secondary reaction to drug therapy, or a decrease in physical activity.Digestive disorders r/t- decreased secretion of HCl in the stomach - decreased digestive enzymes -decreased GI motility -decreased organ functionAltered glucose tolerancethe underlying reason may be a decrease in insulin secretion or a decrease in tissue sensitivity to insulin.Sensory Losses (5)-Hearing loss, -loss of visual acuity, -decreased sense of smell, -decreased number of taste buds -decreased sensation of thirstMalnutrition causes...It impairs quality of life and increases morbidity and mortality. It is linked to diminished cognitive function, physical weakness, and muscle wasting, which increase the risk of falls, fractures, and infections"Anorexia of aging"is a term used to describe the natural decrease in food intake that occurs even in healthy older adults in response to a decrease in physical activity and metabolic rate.Older adults exhibit less hunger and earlier satiety than younger adultsMini Nutritional Assessment12-14 points: Normal nutritional status 8-11 points: At risk of malnutrition 0-7 points: Malnourishedsarcopeniais the degenerative loss of skeletal muscle mass, quality, and strength associated with aging It occurs when age-related loss of skeletal muscle mass is accompanied by loss of muscle strength and function. Advanced sarcopenia is characterized by physical frailty, increased likelihood of falls, impaired ability to perform ADL, and diminished quality of lifeSarcopenic obesityis obesity characterized by loss of muscle mass and strength combined with an increase in body fat mass. Sarcopenic obesity results in worse physical functional declines than just sarcopenia or obesity aloneDysphagia complicationscan lead to inadequate food intake, dehydration, weight loss, and malnutrition. Quality of life is impaired, and the risk of aspiration pneumonia increasesWhat is a liberal diet?It is basically a healthy diet of nutrient-dense foods that contains neither excessive nor restrictive amounts of fat, cholesterol, sugar, and sodiumPhysical activityis good for all people, including the older adult. Being physically active (1) lowers the risk of heart disease, stroke, and diabetes, (2) reduces depression symptoms (not anxiety symptoms), and (3) improves thinking Staying active will increase or maintain strength and balance, allowing for continued independence and the prevention of injuriesincontinenceUrge incontinence is caused by an overactive detrusor muscle causing involuntary bladder contraction. Stress incontinence is caused by pelvic floor muscle weakness or urethral hypermobility. Incontinence occurs when the bladder muscle distends and urine is forced out. Functional incontinence occurs when a physical or psychological impairment impedes continence despite a competent urinary system