chapter 19 the geriatric client. 19-2 copyright 2004 by delmar learning, a division of thomson...

Chapter 19

The Geriatric Client

19-2Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.

The US Census Bureau Definition of Older Adults

Persons 65 years and older divided into three categories:• 65 to 74 years• 75 to 84 years• 85 plus years


United States Demographics of Older Adults

In 1900, the average life expectancy was 47 years.

In 2000, the average life expectancy was over 75 years.

At present, the average American life span is nearly 85.


United States Demographics of Older Adults

In 2000, there were over 50,000 centenarians living in the United States.

By 2030, there are expected to be 70 million older persons (20% of the population).


Quality of Life Among Older Adults

Older adults often assume new roles, such as grandparents as they mature.


Theories of Aging

Biological Theories• Stochastic theories hypothesize that aging

occurs randomly and persistently with time.• Nonstochastic theories suggest that aging is

predetermined.


Biological Theories of Aging

Stochastic Theories• Error• Free Radical• Cross-Link• Clinker• Wear and Tear


Biological Theories of Aging

Nonstochastic Theories• Programmed• Neuroendocrine• Immunologic/Autoimmune


Psychosocial Theories of Aging

Disengagement Theory Continuity Theory Activity Theory


Disengagement Theory

As individuals age, they inevitably withdraw from society.

Society withdraws from them. This separation is mutually agreed upon.


Continuity Theory

An individual’s values and personality develop over a lifetime.

Goals and individual characteristics will remain constant throughout life.

An individual will tend to repeat successful adaptive strategies.


Activity Theory

Satisfaction with life depends on involvement in new interests, hobbies, roles, and relationships.

Volunteering is one way that many retirees stay connected to the community.


Myths and Stereotypes of Aging

Society is youth-driven. Older adults are often stereotyped as

being ill, bald, hard of hearing, forgetful, rigid, grumpy, or boring.

Many younger Americans think that all older people live in nursing homes.


Myths and Stereotypes of Aging

Ageism is the process of stereotyping and of discriminating against people because of their age.

Fear and lack of exposure to older individuals contribute to ageism.


Quality of Life Among Older Adults

The increasing life span has both positive and negative outcomes.

Outlook and adaptation contribute to a high quality of life.

Most older people accept a certain amount of declining health as normal and expected.


Biopsychosocial Changes Associated with Aging

Developmental Physiological Psychosocial


Developmental Changes

Certain developmental challenges bring opportunities for older people to experience feelings of success.


Opportunities for Older People to Experience Feelings of Success

Gaining insight or wisdom Developing better social skills Becoming more open-minded and

tolerant Finding an unexpectedly active and

pleasurable sexual dimension



Seeing children transform into responsible, successful adults

Becoming a grandparent Holding civic and community positions of

responsibility Developing new skills, hobbies, and

interests



Renewing and deepening one’s relationship with one’s spouse, significant others, or friends

Gaining new knowledge and experiences Accepting and adjusting to physical

changes associated with aging


More Challenging Developmental Tasks

Death of a spouse Major declines in health or physical ability Loss of social role, prestige, occupation,

income Loss of independent living Accepting a fixed income


Physiological Changes Associated with Aging

Decrease in rate of cell mitosis Deterioration of specialized nondividing

cells (such as neurons) Decreased elasticity and increased

rigidity of connective tissue Decreased functional capacity



The rate of aging is influenced by:• Genetic composition• Lifestyle (dietary and exercise patterns)• Previous experience• Presence of chronic illnesses• Environmental influences


Neurological Changes Associated with Aging

Sensory and perceptual responses are altered as a result of:• Dcrease in number of neurons• Slowed transmission of nerve impulses• Decreased number of neurotransmitters• Decreased sensory threshold


Sensory and Perceptual Changes Associated with Aging

Vision Hearing Taste and Smell



Vision• Presbyopia• Cataracts• Glaucoma• Macular degeneration



Hearing• Cerumen becomes drier and can cause

blockage of transmission of sound.• Presbycusis is the hearing loss associated

with aging.



Taste and Smell• Taste sensation decreases.• Olfactory nerve cells decrease in number.



Pain Perception• Some adults seem to lack specific

responses to pain.• Clients may have a silent myocardial

infarction, appendicitis, or delayed responses to cold or heat.


Cardiovascular Changes Associated with Aging

Cardiovascular system functions less efficiently in general.

Reduced elasticity of the heart muscle and arteries leading to increases in systolic blood pressure.

Increased fat deposits form in the blood vessels.


Cardiovascular Changes Associated with Aging

Decreases in arterial diameter due to arteriosclerosis

Thickening of venous walls leading to decreased elasticity

Thickening of aortic and mitral valves leading to incomplete closure


Respiratory Changes Associated with Aging

Decreased functional respiratory reserve capacity

Generalized decreased elasticity and tone of muscles necessary for respiration

Fewer functioning alveoli Decreased number of cilia


Gastrointestinal Changes Associated with Aging

Mouth• Loss of teeth• Atrophy of oral mucosa• Decreased saliva production



Gastrointestinal Tract• Decrease in peristaltic action• Relaxation of lower esophageal sphincter• Decreased emptying of the esophagus and

stomach



Gastrointestinal Tract• Slowing of intestinal motility• Shrinkage of gastric mucosa• Changes in levels of hydrochloric acid• Fat intolerance• Decreased absorption of nutrients and fluids



Gastrointestinal Tract• Constipation• Loss of sphincter control


Genitourinary Changes Associated with Aging

Loss of muscle tone in bladder and ureters can lead to urinary retention.

Residual urine can lead to bladder infection.



Decreased Bladder Capacity • Nocturia (nighttime elimination)• Polyuria (excessive urination)



Risk for Renal Failure• Fewer functioning nephrons• Slowed glomerular filtration rate• Diminished blood flow to the kidneys


Fluid and Electrolyte Imbalance

Secondary to fluid retention and/or dehydration.

Dehydration is a very real threat for many older adults.• Composition of body water declines from

60% to 40% of total body weight.


Endocrine Changes Associated with Aging

Slowing of Metabolism Alteration in Pancreatic Activity

• Increased level of insulin and circulating glucose


Endocrine Changes Associated with Aging

Decreased blood levels of growth hormone, estrogen, and testosterone evidenced by:• Enlargement of prostate gland• Loss of elasticity in breast tissue• Decreased size of uterus and fallopian tubes


Reproductive/Sexual Changes Associated with Aging

Sexual dysfunction is not an inevitable result of the aging process.

Older adults who are sexually active may need education about sexually transmitted diseases (STDs), including AIDS.



Changes in men• Testes become softer and smaller.• Sperm production is inhibited or decreased.• Ejaculations are less forceful.• Causes of erectile dysfunction may have

multiple etiologies.



Changes in women due to decline in serum levels of estrogen:• Thinning of vaginal walls• Decrease in vaginal secretions• Decrease in vulva, external genitalia and

breast size• Sleep disturbances• Hot flushes or flashes, and diaphoresis


Musculoskeletal Changes Associated with Aging

Decrease in height Stooped posture Osteoporosis and kyphosis)

• Occur primarily as a result of calcium loss• More common in women• Implicated in estrogen loss


Musculoskeletal Changes Associated with Aging

Ligaments, tendons, and joints become hardened, more rigid, less flexible. • Secondary to collagen loss

Cartilage wears down around the joints, causing painful flexion.


Integumenary Changes Associated with Aging

Skin • Dry, wrinkled, flaccid• Elongated ears, jowls, double chin• Decrease in subcutaneous fat • Decrease in moisture content• Decrease in numbers of elastic fibers • Decrease in numbers of epidermal cells • Skin tears more easily



Lentigo senilis (age spots) • Benign, brown pigmented areas on face,

hands, and arms)

Hair becomes thinner, grey, on head and elsewhere on body.

Nails thicken and become more brittle.



Sweat glands decrease.• Heat exhaustion• Increased susceptibility to cold



Alteration in Mental Status• Acute Confusion• Dementia• Depression


Alterations in Mental Status Associated with Aging

Acute Confusion• State of diminished awareness and attention• Typically of short duration• Varying levels of confusion



Dementia• Chronic, irreversible, impaired cognitive

function• Alzheimer’s disease most common dementia



Depression• Altered mood state lasting at least 6 weeks• Exaggerated sadness, apathy, and

preoccupation with negative thoughts


Depression and Aging

Late life depression can be successfully treated.


Psychosocial Changes Associated with Aging

Retirement• Factors related to successful retirement:

- Attitude- Staying connected to others.- Personal expectations- Financial status



Social Relationships and Roles• Widowhood• Relocation• Grandparenthood



Grandparenthood• Source of pride and happiness


Grandparenting Caregiver Role

Factors related to grandchild’s parents: - Divorce, death- Unemployment- Abuse/neglect of child- Substance abuse- Incarceration



Living Arrangements• Options depend on income, health status,

activity level, support systems



Options for Living Arrangements• Independent living• Living with children• Assisted Living Facilities (ALFs)• Residing in a nursing home• Foster care• Group homes



Coping with Loss• Loss is an inevitable part of life.• The longer a client lives, the more losses will

be experienced.• Feelings of isolation, hopelessness, and

anger can lead to depression.


Coping with Loss

Interventions that promote a sense of hope• Helping older adults stay connected with

others in the community• Reflection on successes and shortcomings


Medications and the Older Adult

Polypharmacy Medication errors Noncompliance Adverse drug reactions Inappropriate prescribing Excessive drug costs


Medications and the Older Adult

Factors related to noncompliance:• Polypharmacy• Cost of drugs• Limited mobility• Impaired memory• Complicated dosing schedules, regimens• Small print on medication labels


Mistreatment of Older Adults (Elder Abuse)

Many abused older adults may not admit to abuse because of embarrassment and/or fear of reprisal.

Most states have an Adult Protective Services program.


Mistreatment of Older Adults (Elder Abuse)

Physical abuse Neglect (includes self) Psychological abuse Exploitation


Nursing Process and the Older Adult

Gerontological nursing is one of the profession’s most challenging practice areas.

Professional standards for gerontological nurses were developed by the ANA in 1955.



Assessment• Health History• Physical Examination



Frequently selected nursing diagnoses• Impaired Physical Mobility• Activity Intolerance• Self-Care Deficit• Social Isolation• Acute Confusion



Outcome Identification and Planning• Individualized to each client• Developed in partnership with the older

client and client’s support system• Realistic for client’s current status and

desired goals• Targeted to maintain a certain level of health

or restore to a former state of health



Implementation• Maintaining physical health• Promoting safety• Providing restorative care• Supporting psychosocial well-being


Implementation

Maintain Physical Health• Skin care• Sensory deficits• Activity tolerance levels


Implementation

Support Psychosocial Well-Being• Use of touch and therapeutic communication• Encouragement of activities• Involvement of support system• Teaching how to cope with alterations in

mental status• Referrals to community services


Implementation

Promote a Safe Environment• Smoke alarms• Secure loose rugs• Grab bars in tub/shower • Shoes with flat rubber soles • Adequate nonglare lighting, nightlights• Handrails next to stairs and long hallways


Implementation (Rehabilitation)

Restorative Care• Clients who have residual impairment as a

result of disease or injury• Increase independence and ability to

perform self-care• Regain or continue maximal functional ability



Evaluation• Whether or not goals have been met or

partially met• Achievement of projected outcomes


Advances in Quality of Life and the Human Genome Project

Improve the early diagnosis and prevention of disease

Identify more diseases that could be treated

Research in tissue replacement

chapter 19 the geriatric client. 19-2 copyright 2004 by delmar learning, a division of thomson...

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