Chapter 14
Older Adults
Copyright © 2013, 2009, 2005 by Mosby, an imprint of Elsevier Inc.
Variability Among Older Adults
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Physiological, cognitive, and psychosocial
health
Levels of functional ability
Dependence vs. independence
Strengths and abilities
Copyright © 2013, 2009, 2005 by Mosby, an imprint of Elsevier Inc.
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Myths and Stereotypes
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Older adults are:
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Ill, disabled, and unattractive
Forgetful, confused, rigid, boring, and unfriendly
Unable to learn and understand new information
Not interested in sex or sexual activities
These ideas demonstrate ageism, which is
discrimination against people because of
increasing age.
Copyright © 2013, 2009, 2005 by Mosby, an imprint of Elsevier Inc.
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Case Study
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Sam is a nursing student assigned to a long-term
care facility for his clinical rotation. Because Sam is a
first semester nursing student, he is assigned to only
one patient, Mr. Bob Calder. Mr. Calder, an 87 y/o
Caucasian, has a reputation of being quite stubborn
and noncompliant with his plan of care.
Before his shift begins, Sam pokes his head into Mr.
Calder’s room to say a quick hello and to introduce
himself. He informs Mr. Calder that he will return
shortly to perform an assessment and give Mr.
Calder his morning medication.
Copyright © 2013, 2009, 2005 by Mosby, an imprint of Elsevier Inc.
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Nurses’ Attitudes Toward
Older Adults
Nurses need to recognize and address ageism
by questioning prevailing negative attitudes and
stereotypes and reinforcing the realities of aging
as they care for older adults in all care settings.
It is critical for you
to learn to respect older adults and
actively involve them in
care decisions and activities.
Copyright © 2013, 2009, 2005 by Mosby, an imprint of Elsevier Inc.
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Theories of Aging
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Biological theories
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Stochastic or nonstochastic
Psychosocial theories
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Disengagement
Activity
Continuity or developmental
Gerotranscendence
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Developmental Tasks for Older
Adults
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Linked to the concept of developmental tasks
appropriate for stages in life
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Deaths of friends and significant others, retirement
and reduced or fixed income, changes in quality of
life or living arrangements
 Redefining relationships
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Structural and functional changes: Failing
health and physical strength
Self-acceptance
Copyright © 2013, 2009, 2005 by Mosby, an imprint of Elsevier Inc.
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Case Study (cont’d)
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Upon Sam’s return to Mr. Calder’s room, he
asks Mr. Calder what activities he enjoys
participating in at the nursing home. Mr.
Calder informs Sam that he is an avid
baseball fan and never misses a televised
game of his favorite team.
During Sam’s assessment of Mr. Calder, they
talk about baseball, which makes Mr. Calder
compliant with Sam’s assessment and health
history questions.
Copyright © 2013, 2009, 2005 by Mosby, an imprint of Elsevier Inc.
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Community-Based and
Institutional Health Care Services
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Nurses encounter older-adult patients in a
wide variety of community and institutional
health care settings:
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Private homes, apartments, retirement
communities, adult day care centers, assistedliving facilities, and nursing centers
Older adults need to help with decisions
regarding which type of health care service is
appropriate for them.
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Assessing the Needs of Older Adults:
Age-Specific Approach
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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
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Older Adult Interview Techniques
Sit or stand at eye level, in front of
the patient in full view.
Face the older adult while speaking; do
not cover your mouth. Speak clearly.
Provide diffuse, bright, nonglare
lighting.
Encourage the older adult to use his or
her familiar assistive devices such as
glasses or magnifiers.
Copyright © 2013, 2009, 2005 by Mosby, an imprint of Elsevier Inc.
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Assessment
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Use caution when interpreting signs and
symptoms of diseases and laboratory values.
It is important to recognize early indicators of
an acute illness in older adults.
Some mental changes are often drug related,
caused by drug toxicity or adverse drug
events.
Many conditions are common causes of
functional decline; thus nurses are essential
in early identification, referral, and treatment
of health problems in older adults.
Copyright © 2013, 2009, 2005 by Mosby, an imprint of Elsevier Inc.
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Physiological Changes
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Perception of well-being defines quality of life.
Older patients’ concept of health revolves
around how they perceive their ability to
function.
Nurses need to be cognizant of normal agerelated changes.
Not all physiological changes are
pathological.
Copyright © 2013, 2009, 2005 by Mosby, an imprint of Elsevier Inc.
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Physiological Changes (cont’d)
General
Survey
Integumentary
System
Head and Neck
Thorax and
Lungs
Heart and
Vascular System
Breasts
Gastrointestinal System and
Abdomen
Urinary
Musculoskeletal
System
System
Reproductive
System
Neurological
System
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Functional Changes
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Functional status in older adults includes the
day-to-day activities of daily living (ADLs)
involving activities within physical,
psychological, cognitive, and social domains.
Changes are usually linked to illness or to
disease and degree of chronicity.
Performance of ADLs is a sensitive indicator
of health or illness.
Occupational and physical therapists are your
best resources for a comprehensive
assessment.
Copyright © 2013, 2009, 2005 by Mosby, an imprint of Elsevier Inc.
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Case Study (cont’d)
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Sam performs his assessment of Mr. Calder.
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What findings are considered normal for a patient
of Mr. Calder’s age?
(Select all that apply.)
A. Thin skin
B. Decreased saliva production
C. Decreased muscle strength
D. Whitening of the eye lens
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Cognitive Disorders
Delirium
Acute confusional state
Dementia
Generalized impairment of
intellectual functioning
Depression A mood disturbance
characterized by feelings of
sadness and despair
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Nursing Management of
Dementia
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Nursing management of older adults with any
form of dementia always considers the safety
and physical and psychosocial needs of
the older adult and the family.
These needs change as the progressive
nature of dementia leads to increased
cognitive deterioration.
To meet the needs of the older adult,
individualize nursing care to enhance quality
of life and maximize functional performance
by improving cognition, mood, and behavior.
Copyright © 2013, 2009, 2005 by Mosby, an imprint of Elsevier Inc.
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Psychosocial Changes
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Retirement
Social isolation
Sexuality
Housing and
environment
Death
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Quick Quiz!
1. A nurse who has recently graduated has been
assigned to be a primary nurse on a geriatric unit.
After completing a review of development and aging,
the nurse recalls that changes for the older adult
include
A. A transition from young adulthood.
B. The ability of the older adult to achieve sexual
arousal.
C. A time when cognitive performance begins to peak.
D. Adjusting to decreasing health and physical strength.
Copyright © 2013, 2009, 2005 by Mosby, an imprint of Elsevier Inc.
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Healthy People 2010 Goals: Older
Adults
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Increasing the number with one or more
chronic conditions who report confidence in
maintaining their conditions
Reducing the number with moderate to
severe functional limitations
Reducing the number of emergency
department visits resulting from falls
Copyright © 2013, 2009, 2005 by Mosby, an imprint of Elsevier Inc.
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Healthy People 2010 Goals: Older
Adults (cont’d)
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Increasing the number
who live at home but
have unmet long-term
services and support
Increasing the number
with reduced physical or
cognitive function who
engage in leisure-term
physical activities
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Health Promotion and Maintenance:
Physiological
Heart disease
Cancer
Stroke
Smoking
Alcohol abuse
Nutrition
Dental
problems
Exercise
Falls
Sensory
impairments
Pain
Medication
use
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Health Promotion Preventive
Measures
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Participation in screening activities
Regular exercise
Weight reduction, if overweight
Eating a low-fat, well-balanced diet
Moderate alcohol use
Regular dental visits
Smoking cessation
Immunizations
Copyright © 2013, 2009, 2005 by Mosby, an imprint of Elsevier Inc.
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Case Study (cont’d)
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Sam notices that Mr. Calder’s face is gaunt
and drawn in appearance.
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Sam knows that thinning of the face in the elderly
is due to ____________________.
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Health Promotion and Maintenance:
Psychosocial Concerns
Therapeutic
communication
Touch
Reality orientation
Validation therapy
Reminiscence
Body image
interventions
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Older Adults and the Acute Care
Setting
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Acute care settings pose risks for adverse
events:
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Delirium
Dehydration
Malnutrition
Health care–associated infections
Urinary incontinence
Falls
Copyright © 2013, 2009, 2005 by Mosby, an imprint of Elsevier Inc.
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Case Study (cont’d)
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Mr. Calder’s blood pressure is 162 systolic/92
diastolic.
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True or False: Mr. Calder’s hypertension is a
normal sign of aging.
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Quick Quiz!
2. Which of the following might be a cause of
stress for the older adult?
A. Financial security
B. Planned retirement
C. Maintaining satisfactory living environment
D. Adjusting to decreasing health and physical
strength
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Older Adults and Restorative Care
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Types of ongoing care:
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Continues recovery from acute illness
Addresses chronic conditions that affect daily
functioning
Goal
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To regain or improve prior level of independence,
ADLs, instrumental ADLs (IADLs)
Copyright © 2013, 2009, 2005 by Mosby, an imprint of Elsevier Inc.
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