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Care of Older Adults P & A

Terms in this set (69)

Delirium
is a temporary state of acute confusion. Hyperalert, restlessness, agitation, misperception, hallucinations.
Often first sign of infecting
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.
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
Wisdom
Enables a person to look back on their life with a sense of closure and completeness, and accept death without fear
Validation therapy
involves 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 agitation
Presbyopia
A gradual, age-related loss of the eyes' ability to focus actively on nearby objects
Presbycusis
is 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 cerumen
Because there is a decrease in the sebaceous gland function, the ear wax becomes very dry and may become "packed" in the ear canal
Decrease in Proprioception
The ability to know where our bodies are in time and space, this leads to a decreased sense of balance and coordination
Incontinence, is it normal?
It is not a normal part of aging, so pt should seek medical interventions. It it more common in women
S & S of Acute Illness
Confusion, falls, dehydration, decreased appetite, decreased of function of ADLs, dizziness and incontinence
Normal memory loss?
Mild short term memory, like forgetting where keys or wallet is, is considered a normal part of aging
ALtered Cognitive Function Signs
Cognitive/thinking impairment
Disorientation
Poor Judgment
Loss of Language skills
Folsteins Mini-Mental State Exam
most commonly used tool
Clock drawing test
Warning 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/personality
Apraxia
is 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 hear
Disorientation
Confusion about time and place, they may forget where they are, forget why they are somewhere or what they are doing
Misplacing things
in very odd places, like a phone in the fridge
Changes In Mood, AD
Rapid mood changes, from calm, to tears, to anger. Personality changes, suspicious, fearful withdrawn, becoming passive
Numbers of AD
Accounts for 60-80 % of all Dementia pt
75+ is about 20% of population
Early progression in AD
Early- short term loss that is apparent to close relatives, losing or misplacing things, decreases ability to plan
Mid progression in AD
Mid- personality changes, unable to recall important info (like their phone number or address), but memory of self and family remains, disorientation and confusion
Late Progression in AD
May recall own name but unable to recall personal history, loss of awareness of surroundings, unrecognizable speech, incontinence, inability to eat without assistance or impaired swallowing
Vascular Dementia
caused by trauma or circulatory problems
Main traits of AD
Progressive and irreversible
Usually 7 years after diagnosis
Memory Loss
Problems with Judgement
Change in personality
Cholinesterase inhibitors
Used mild to moderate dementia
Blocks cholinesterase, an enzyme that breaks down acetylcholine.
Helps stabilize cognitive decline but does not cure it
Acetylcholine
is 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 cells
Effects 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 CURE
Aricept
Trade name for Donepezil hydrochloride
A Cholinesterase inhibitor
s/e nausea, diarrhea, sleep disturbance
Namenda
Trade name for Memantine
A treatment for AD
Protects nerve cells amounts of glutamate
Stabilizes deterioration
Effects of Glutamate
excess amounts contribute to the death of brain cells in pt with AD
Goal of nursing interventions of AD
-Decrease clinical manifestations
-Prevent harm
-Support pt and family
Nursing 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 programs
Sundowning
Nocturnal delirium.
Confusion/agitation that increases within 1 hour of night
*Occurs most freq. with pt that are significantly cognitively impaired
Nursing 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 needs
There is a decrease in calorie requirement
However, minerals, vitamins and protein intake should remain the same
What is the NIA?
National institute On Aging
Medication Toxicity
Older 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 body
What 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 spouse
What 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 night
Factors 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 cognition
Elderly are at risk for infection r/t
Humoral immunity declines because of changes in T-cell function, and older adults have lower antibody response to microorganisms that cause pneumonia and infection
the 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 populaiton
The older population - persons 65 or older - represent 13.7 % of the US population in 2012
Constipation 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 function
Altered glucose tolerance
the 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 thirst
Malnutrition 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 adults
Mini Nutritional Assessment
12-14 points: Normal nutritional status
8-11 points: At risk of malnutrition
0-7 points: Malnourished
sarcopenia
is 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 life
Sarcopenic obesity
is 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 alone
Dysphagia complications
can lead to inadequate food intake, dehydration, weight loss, and malnutrition.
Quality of life is impaired, and the risk of aspiration pneumonia increases
What 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 sodium
Physical activity
is 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 injuries
incontinence
Urge 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
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