Fundamentals of Nursing: Human
Health and Function
Chapter 9:
Caring for the Older Adult
Learning Objectives
 1. Describe the demographics of older adults in
North America
 2. Discuss a comprehensive knowledge base that can
help nurses display commitment to providing
humane and dignified care.
 3. Explain functional and physiologic changes that
place older adults at greater risk for declines in
health and quality of life.
 4. Identify health promotion and health
maintenance strategies that can give older adults
advantages in maintaining optimal health.
Demographics
 People 65 years or older: 37.9 million in
2008, increasing as Boomers age
 12.8% of the U.S. population & growing
 Life expectancy has increased for both men
and women

R/T decreased death in infants & children
 Population is older, more minority
 Increase in chronic illness, multiple illnesses in older adults
Demography
Number of people 65+ in US
[in millions]
Considerations with older clients
 Mental status may be normal or impaired
 Perception affects communication, memory, judgment

Always assess sensory perception and LOC
 Polypharmacy [many drugs] can cause interactions
 Self-care may be impaired
 by physical and mental disease, decreased ROM, fatigue, fear
of falling, decreased eyesight
 Age influences values and culture, health beliefs
 Use appropriate communication techniques for
clients with different problems
Cognition and Communication, Mood, and SelfCare
 Cognition and communication
 Irreversible
confusion
Alzheimer’s, Parkinson’s
 Use validation not reorientation [don’t argue]
 Assess and meet current needs
 Acute confusion
Delirium, medication effect
 Use reorientation, minimize sensory stimulation
 Reality orientation
 Assess status of sensory aides and promote use
Cognition and Communication, Mood, and SelfCare (Cont’d)
 Mood
 Depression
 Often
unrecognized; symptoms similar to dementia
 Common with chronic illness, isolation, loss of
independence
 Older, white males have highest suicide rates
 Delusional
disorder, bipolar disorder, anxiety
disorder, and schizophrenia
 Not
specific to older adults but meds side effects
increase confusion, fall risk
 Self-care

Assess needs and make appropriate referrals
Mobility, Elimination, and Skin Integrity
 Mobility
 Arthritis
 Gait
and balance disorders
 Cataracts
 Impairments: hemiparesis, ataxia, spasticity,
coordination or balance problems
 Assess
degree of impairment, impact on ADL’s
 Interventions to promote independence, safety
Mobility, Elimination, and Skin Integrity (Cont’d)
 Elimination
 Incontinence
[any involuntary urine loss]
Urge
overactive bladder muscle– spasms
 Stress
Weak pelvic floor musculature
 Either may increase fall risk [hurrying]
 Overflow
Distention of bladder
 Functional
Physical or psychological w/intact system
 Interventions depend on type of
incontinence

Mobility, Elimination, and Skin Integrity (Cont’d)
 Skin integrity
 Older skin is more easily damaged
 Injury
from falls
 Problems with positioning
 Incontinence
 Pressure ulcers
 Assess risk and skin integrity in all older
clients
Question
true or false:
Pressure ulcers are lesions caused by
unrelieved pressure that results in damage to
underlying tissue.
Answer
True.
Rationale: Pressure ulcers are lesions caused
by unrelieved pressure that results in damage
to underlying tissue. Many factors predispose
an individual to having pressure ulcers;
factors can be physical, functional, and
psychosocial.
Nutrition and Health Maintenance
 Food intake declines with aging
 Decline in physical activity
 Protein depletion
Chronic Illness, Infections, and Immunity
 Chronic illness
 Contributes
to poor nutrition in many ways
Medications,
disease process, fatigue, mobility, $
 Careful nutritional assessment and patient-
specific interventions

Access Resources, treat dry mouth, assess needs
 Prompt and aggressive treatment of health
disorders

Pain, dental problems, depression, altered taste
Chronic Illness, Infections, and Immunity (Cont’d)
 Infections and immunity
 Humoral
immunity declines
 Lower
antibody response to vaccines, pathogens
 Increased risk of pneumonia, flu
 New immunizations for older adults
 Inadequate
 Decreases
 Chronic
nutrition
immune response
illnesses
Decrease
overall health and immune response
Sleep and Rest
 Sleep impaired due to the following:
 Medications
 Restless
 Sleep
legs syndrome
apnea
 Pain
 Cardiovascular
and pulmonary disorders
Question
Which of the following conditions can
interfere with sleep in older patients?
a. Ataxia
b. Spasticity
c. Restless legs syndrome
d. Hemiparesis
Answer
c. Restless legs syndrome
Rationale: The uncomfortable sensation in
legs relieved by moving or rubbing legs is
called restless legs syndrome.
It affects sleep and rest. Ataxia, hemiparesis,
and spasticity impair mobility.
Pain Management
 Chronic pain
 Osteoarthritis
 Neuropathic
pain
 Central or neuropathic pain after stroke
 Postherpetic neuralgia
 Phantom limb pain
 Barriers to effective pain management
 Misconceptions, fear of addiction
 Pain management crucial for quality of life
Loss and Grief, Loneliness, and Coping and Stress
 Loss and grief

Losses more frequent with aging
 Grief reactions: Shock, disbelief, anger, or
denial of the loss
 Adaptive coping

Social support, therapy, religion, talking
 Maladaptive coping

Alcohol or drug use to numb pain
 Nursing interventions support adaptive coping
Loss and Grief, Loneliness, and Coping and Stress
(Cont’d)
 Loneliness
 Loss of important relationships
Spouse, friends, etc.
 Sensory losses
Lead to isolation, communication problems
 Depression
Increases isolation
 Cognitive disorders
Decrease meaningful interactions
 Cultural differences and language barriers
Impair communication, increase lonliness
Loss and Grief, Loneliness, and Coping and Stress
(Cont’d)
 Coping and stress
 Older adults vary in perception and reaction
to stressors – assess and treat individually
 Emotion-focused
Change
the way stress is perceived
 Problem-focused
Change
the situation
Question
true or false:
Emotion-focused coping involves attempts to
reduce stress by changing the stressful
situation.
Answer
False.
Rationale: Problem-focused coping involves
attempts to reduce stress by changing the
stressful situation. In emotion-focused coping,
the individual attempts to change the way he
or she thinks about or appraises a stressful
situation rather than changing the situation
itself.
Sexuality, Roles and Relationships, and SelfPerception
 Sexuality
 Myth:
Sexual desire or activity diminishes
with age
 Reproductive system loses efficacy
 Physiologic changes
 Medical conditions
Sexuality, Roles and Relationships, and SelfPerception (Cont’d)
 Roles and relationships

Multiple roles [caring for aging parents, children,
grandchildren] may stress ability
 Careful
assessment of physical and
psychological health
 Referral to appropriate healthcare
providers
 Assistance in accessing agencies that
provide help to caregivers
Sexuality, Roles and Relationships, and SelfPerception (Cont’d)
 Self-perception
 The
older adult’s multiple evolving roles
define his or her self-concept
 Incorporates physical functioning,
cognition, social relationships, and life
experiences
Values, Beliefs, and Spirituality
 Source of health and healing power


Coping mechanism
Support system
 Gerotranscendence

Shift from material world to cosmic world with age
 Approaching dying, end-of-life care