Older Adult Care and Changes
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| Ageism | discrimination against people because of age
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| Geriatrics | deals with the diagnosis and treatment of diseases and problems affecting older adults
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| Gerontology | Study of all aspects of the aging process and its consequences
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| Gerontological nursing | Concerned with assessment of the health and functional status of older adults, diagnosis, planning, and implementation
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| Gerontological nursing | Assessment of health and functional status of older adults; diagnosis, planning, and implementing health care and services to meet needs and evaluates care.
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| Gerontic nursing | Seldom used term, considers the nursing care of older adults to be the art and practice of nurturing. Caring, and comforting rather than the treatment of disease
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| Theories of Aging | Sociologic, Biologic, and Psychologic
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| Sociologic Theories of aging | Disengagement Theory (social disengagement occur), Activity R (must maintain high level of activity & involvement), Continuity T (Personality remains same & behavior more predictable as people age)
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| Biologic Theories of aging | Wear-and-tear theory, Free-radical theory (Oxidation releases chemicals - affect membranes & DNA replication, Immune theory (decrease in T cells)
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| Psychologic Theories | Short-term memory suffers decline, Long-term memory undergoes minimal change, Memory affected by changes in enviro., moving, changes in caregivers
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| Aged are vulnerable to disease because of | decreased physiologic reserve, less flexible homeostatic processes, and less effective body defenses
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| Lack of sleep occurs why? | Shorter sleep stages, NREM 1-4 and REM, Easily awakened by environmental stimuli, Nap during daytime hours
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| Cardiovascular System changes for age | dysrhythmias, CO decrease, BP incr., valves calcify, Arteriosclerosis incr., PVD, edema, CAD (MI, HF), hearts contractility decreases
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| Respiration System Changes for age | resp muscles become rigid, decreased cough reflex, dec. pulmonary circ, gas exchange reduced
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| GI system changes for age | delayed emptying, aspiration, decr. Peristalsis, hunger decr, HCL and pepsin decr, decr pancreatic & liver enzymes, dec bile, loss of teeth, constipation
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| Genitourinary System kidney changes for age | kidney size decr - fewer nephrons, glom filtration rate decr due to decr renal blood flow, Tubular function diminishes, protein in urine
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| Bladder changes due to age | capacity size decr, urinary frequency & nocturia, weakening of bladder & perineal muscles, incontinence & dribbling
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| Skin changes due to age | reduc skin elasticity, decr collagen, slower epithelialization & wound healing, dypodermis decreases in size, less sub Q
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| Muscular changes with age | muscle cells lost and not replaced, muscle mass decr
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| Skeletal changes with age | bone loss, cartilage erosion, ROM decr
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| Integumentary System changes with age | thinning skin, less subQ, less elastin and collagen, brittle and thick nails,
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| Visual changes with age | Decreased accommodation to near/far, Difficulty adjusting to changes from light to dark, Yellowing of the lens, Altered color perception, sensitivity to glare, Smaller pupils
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| Hearing changes with age | Presbycusis, high-pitches diminishes first, Ability to discriminate tones is lost, Thickening of tympanic membrane, Buildup of cerumen
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| Presbycusis | age-related decrease in hearing acuity, auditory threshold, pitch and tone discrimination, and speech intelligibility
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| Taste changes with age | less taste buds and they atrophy
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| Neurological changes with age | Cerebral blood flow & oxygen utilization decr, Neurons do not regenerate; Peripheral nerves, decrease in both autonomic & sympathetic NS
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| Cognitive Changes |
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| Three conditions affecting cognition | Delirium, Dementia, Depression
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| Delirium | starts abruptly, potentially reversible - often due to physiological cause, Electrolyte imbalances, Medications, Drug effects, Systemic infections, hypoglycemia
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| ESSENTIAL feature of delirium | disturbance in consciousness
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| Goal for treating delirium | treat the underlying condition - Sustained neuro damage can lead to irreversible changes (dementia or death)
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| Autonomic manifestations of delirium | tachycardia, sweating, flushed face, dilated pupils, elevated BP
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| Consciousness signs of delirium | Disturbance in level of consciousness, Illusions or hallucinations, Distractibility & disorganized thinking, Rambling, irrelevant incoherent speech, Disorientation to time & place
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| Sundowners | delirium may be more pronounced in the evening or an institutional setting
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| Dementia | Permanent, progressive impairment in cognitive functioning - memory loss (long-term & short-term), impairment in judgment, abstract thinking, & social behavior
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| 2 common types of dementia | Multiinfarct dementia and Alzheimer disease
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| Secondary Dementia is usually caused by | Infection: TB, syphilis, fungal, bacterial, viral, Trauma + Toxic & Metabolic Disturbances, Neoplasm's + other neuron diseases -Parkinson’s disease
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| Multiinfarct dementia | Results from repeated strokes, which can cause complete deterioration of the cerebral tissue
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| Alzheimer disease | Characterized by brain atrophy, a progressive physical and mental deterioration that lasts 5 to 14 years before death occurs
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| How do you diagnose dementia? | Definitive Dx requires biopsy or autopsy of brain tissue
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| Dementia Theory | Acetylcholine alterations, Accumulation of aluminum, Alterations in immune system, Head trauma, Genetic factor’s: defect in chromosome 1, 14 & 21, Pathological changes--cerebral atrophy & microscopic abnormalities
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| Apraxia | inability to perform simple tasks
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| Agnosia | inability to recognize simple objects - unable to identify familiar objects and people
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| Stage One dementia | primary symptom is memory loss, rate of progression varies, avg life after onset is 8 years but range is 3 to 20 years, impaired ADLs, aphasia
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| Alzheimer's Disease Middle Stage | memory loss increases, hygiene suffers, need care & supervision, agnosia increases, advd apraxia (even simple tasks), wandering behavior (70%)
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| Late stage of alzheimers | lose of ability to talk or walk, urinary & fecal incontinence, death due to secondary causes
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| Multi-infarct dementia | 2nd most common cause of dementia, have periods of remission, May be related to stroke or hypertension
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| Cholinesterase inhibitors | slows down breakdown of acetylcholine (neurotransmitter) - Donepezil hydrochloride (Aricept), Tacrine (Cognex)
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| Cholinesterase inhibitors are given at night because | one of the side effects are drowsiness – give with food for GI irritation reduction – liver impairment
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| Side effects of cholinesterase inhibitors | drowsiness, insomnia, headache, dizziness, confusion, ataxia, anxiety, depression, hostility, abnormal thinking
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| Tricyclics | TCA’s - Block monoamine reuptake, which indicates that TCA’s intensify the effects of the norepinephrine and serotonin
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| Tricyclics take how long to work? | Initial mechanism takes about 1 – 3 wks to develop w/max response achieved in approximately 6 – 8 wks
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| Combination of TCAs and MAOI can lead to | severe HTN (Hypertension) – together they increase heart rate and BP goes up
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| Tricyclics (TCA’s) side effects | orthostatic hypotension, sedation, cardiac toxicity, constipation - Block muscarinic cholinergic receptors
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| Monoamine oxidase inhibitors (MAOIs) | anti-depressants, Not a first choice because of potentially fatal food and drug interactions – rxt w/cheese, meats/fish, draft beer, fruits/veg
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| Taking SSRIs (Selective Serotonin Reuptake Inhibitors) with MAOIs can cause | serotonin syndrome agitation, sweating, confusion, fever, hyperreflexia, tachycardia, hypotension, muscle rigidity, ataxia
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| Selective Serotonin Reuptake Inhibitors (SSRIs) Action | Block reuptake of serotonin & intensify transmission at serotonergic synapses; equivalent to those produced from TCA
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| Name some SSRIs | Fluoxetine (Prozac), Paroxetine (Paxil), Swertraline (Zoloft)
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| Which antidepressants have least side effects | SSRIs have fewer side effects than TCA & MAOI -decreased time between initial dose & beginning of reduced s/s of depression
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| Side effects of SSRIs | Nausea, drowsiness, dizziness, headache, sweating, anorexia
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| Bupropion (Wellbutrin) | antidepressant - Like amphetamines - can suppress appetite; it doesn’t have cardiotoxic, anticholinergic, & anti-adrenergic side effects - can be used safely in elderly - smoking cessation
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| What to monitor with Wellbutrin | Monitor hepatic/renal function closely in pt w/kidney or liver impairment to prevent elevated serum & tissue concentrations - Give w/food to decrease GI side effects (nausea, dizziness)
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| Trazodone (Desyrel) | Second-line agent for the treatment of depression, Usually used in combination with other antidepressants, treats insomnia because pronounced side effect
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