Older Adult Theory Exam 1 Flashcards

What are some myths of aging? Think about our reading from the first week.

1. Most older adults are not care-dependent, and aging isn’t always negative. There is no typical older person. Ageism contributes to negative health outcomes in older adults.

2. Healthy aging isn’t just genetic; that only makes up 25% of health outcomes. Much of it comes from physical and social environment. Good health doesn’t just come from the absence of disease; it represents wellness.

3. There is high amounts of diversity in older populations: Poverty, participation in the workforce, ethnic groups, widowers (3x more common in women), disabilities, and access to healthcare services are diverse.

How will demographics of aging impact nursing practice?

Older adult populations are rapidly increasing over time, contributing to the growing demographic of older adults, and the increased need for caregiving. Having higher portions of the older adult population requires an increase in nursing and other healthcare roles to support this population over time. The population over 60 is going to double in the next 30 years.

This can contribute to higher patient-to-caregiver ratios, higher incidence of patient injury, and healthcare worker burnout in the future.

What are key statistics for the diversity of older adults?

These were the 3 statistics specifically highlighted in her week 1 slides:

1. “Of older adults age 65+ living in the community, 59% lived with their spouse/partner in 2023. About 28% lived alone.”

2. “People 65+ represented 17.3% of the population in the year 2022. That

   percentage is expected to grow to 22% by 2040.”

3. 25% of older adults identified as members of racial or ethnic minority populations in 2022.”

What are some myths regarding sexuality expression in older adults?

• Older adult populations are asexual. This is incorrect. Sex is an important part of intimacy for older adults in relationships and contributes to their social connection.

• Older adults don’t have as many STI’s. This is incorrect. The incidence of STI development has tripled in those over 55. Talking about sexual health is just as important as discussing physical health as healthcare providers. Nurses should encourage using protection.

• Older adults with heart conditions shouldn’t have intercourse. This is incorrect. After an MI, there is a brief waiting period; otherwise, it’s okay! But do not use Nitroglycerin along with Viagra or similar medications.

• Healthcare workers shouldn’t discuss sexual health with older adults. This is the most detrimental myth. Sexual health may tie into other health conditions, STI’s (as mentioned), and interactions with other medications. Nurses should always use therapeutic communication when discussing sexual health.

What are the signs of glaucoma? What is the treatment?

Glaucoma: Excess interocular pressure (IOP) pressure (over 20mmHg) that causes damage to the optic nerve. Results from fluid buildup over time with the inability for the inner liquid to drain. This results in blindness, and effects are permanent. Caused from medications, genetics, age, and comorbidities.

• Treatment: Timolol; beta blockers. This helps to lower interocular pressure.

What are the signs of cataracts? What is the treatment?

Cataracts: When protein builds up on the lens of the eye. This results in blurry vision from the lens turning thick and opaque. More common in older adults. This condition is reversible.

• Treatment: Laser therapy, surgery. This helps break up the proteins and allow for the return of vision.

What are the signs of macular degeneration?

Macular Degeneration: Can be dry (atrophic) from protein deposits (called drusen) forming under the retina. Can also be wet (exudative) from abnormal vessels under the retina leaking, resulting in the accumulation of blood and fluid in this region. This contributes permanent vision loss over time. Blind spots appear in the center of vision.

What are some interventions for patients with vision difficulties?

For Patient Comfort:

• Have regular eye exams.

• Encourage eyeglasses usage.

• Promote adequate lighting.

• Narrate what you are doing.

• Use large fonts.

• Utilize audio resources.

• Use UV protection/sunglasses.

Nursing Interventions:

• Assess PERRLA (pupils) and EOM (eye tracking).

• Check near and far vision.

• Assess peripheral vision.

• Inspect whites of eyes and under the eyes.

What are some interventions for patients with hearing difficulties?

For Patient Comfort:

• Get attention before speaking.

• Utilize pocket amplifiers.

• Use a lower tone of voice.

• Encourage hearing aids, plus proper caring and storage.

Nursing Interventions:

• Inspect ears for excess earwax, redness, or discharge.

• Test hearing ability if this is new in onset (whisper test).

What are some interventions for patients with taste and smell difficulties?

For Patient Comfort:

• Take this seriously! Dramatic changes are not a part of normal aging.

• Educate on using CO detectors and the dangers of not being able to taste or smell.

• Encourage evaluation by an ENT.

Nursing Interventions:

• Inspect nasal mucosa.

• Check sense of smell.

• Inspect lips, oral mucosa, and tongue.

What are some interventions for patients with feeling difficulties?

For Patient Comfort:

• Examine feet daily (especially diabetic pts).

• Apply moisture on skin.

• Check for lesions or wounds.

• Encourage healthy diet.

• Promote ROM exercise, if possible.

• Inform about lower ability to feel temperature, pain with age.

Nursing Interventions:

• Check temperature color, turgor of skin.

• Assess pain.

• Feel pulses on pulse points.

• Test capacity for sensation.

What is the difference between pitting and non-pitting edema?

Pitting: When pressing on the skin, there will be a residual indentation due to fluid overload. This presents bilaterally and can improve with elevation.

Non-Pitting: This is central to the lymph system. If the lymph system isn’t draining fluids in the intracellular space, accumulation will contribute to pitting initially, but will result in fibrotic tissue over time. Unilateral, and does not improve with elevation.

What is the difference between left and right sided heart failure?

Left-Sided Heart Failure: When the heart fails to adequately contract, resulting in decreased stroke volume from the weakness of the heart and excess fluid buildup in the lungs. Can be caused from hypertension, hypertrophy, cardiomyopathy (heart disease), and mitral and aortic valve stenosis (narrowing, preventing flow). This results in shortness of breath and crackles upon examination.

Right-Sided Heart Failure: When the heart fails to adequately contract, resulting in fluid buildup in the tissues (edema). Can be caused from left-sided heart failure and pulmonary hypertension. This can also present with spleno/hepatomegaly, weight gain, distended abdomen (ascites), and JVD due to fluid building up in these areas as well.

What are some risk factors for developing heart disease?

These are just some ways, don’t feel pressured to memorize all of them:

• Chronic low-grade inflammation can occur due to obesity, diet, genetics, the microbiome, alcohol and smoking, sedentary lifestyle, oxidative stress, and infection.

• SNS activity at rest goes up as we get older, resulting in lower cardiac output and higher risk of arrhythmia.

• Atherosclerosis, arterial stiffness, fibrosis, amyloidosis (protein buildup), valve regurgitation, and valve stenosis are more common with age.

• The aorta will thicken over time due to increased demand, resulting in higher oxygen demands and an increase in systolic pressure.

• Aging creates fibrosis of the heart, increasing the risk of heart failure. This happens through the activation of fibroblasts and free radicals.

• Hypertension increases heart failure risk through pressure overload and left-ventricular hypertrophy.

What 3 medications are used to treat HF?

1. Diuretics “-ide”: “Water pill.” Causes excess urination to deplete the extra fluid in the body. Results in excess potassium depletion (hypokalemia), so often prescribed with KCl.

2. Beta Blockers “-olol”: Slows heart rate and widens vessels by blocking epinephrine effects on the heart (stopping SNS effects). May result in burning, eye irritation, and hypotension. Not used for pupil dilation.

3. ACE Inhibitors “-pril”: Inhibits ACE from turning angiotensin I to angiotensin II, which encourages vasodilation (better blood flow) and less stress on the heart. Can contribute to hypotension.

How does nitroglycerin help with heart conditions? What are some effects?

Nitroglycerin is a sublingual vasodilator that can be given 3 times, 5 minutes apart. This results in an increase in blood flow, lower blood pressure, and relief for chest pain (especially in angina). Tingling is normal with this medication. If patients report headaches, place transdermal patches lower away from the head.

Do not expose to light, and do not take with Viagra or similar medications.

What are the symptoms of hypokalemia? What is the normal range for potassium?

Hypokalemia (<3): Normal potassium is 3.5-5.

Potassium helps with heart contraction, helps with muscle movement, and manages fluid maintenance in the body (while offsetting the effects of sodium). Low potassium is dangerous, and often results in symptoms that manifest in the muscles: twitching, numbness, constipation (less peristalsis), fatigue, palpations, and arrythmia. Common in diuretic usage, necessitating prescribing KCl.

What is the difference between angina and MI? How are they treated?

Angina: Vessels are partially occluded, resulting in narrow blood flow. Brought upon from stress or exertion and relieved by rest. Normal labs. Treated using nitroglycerin (vasodilation), aspirin (preventing clots), and anticoagulants (preventing clots).

MI: Vessels are fully occluded, resulting in the lack of blood flow. Not relieved by rest or nitro; elevated troponin levels (enters blood vessels during damage to the heart). Treated using catheterization (angiography/imaging), stents (opens arteries), bypasses (new blood flow routes), or thrombolytic therapy (clot busting medication).

What are some interventions for patients with heart conditions?

For Patient Comfort:

• Encourage movement, if safe, to help with circulation.

• Manage fluid balance; decrease fluids if signs of edema. Regularly check weight because of this.

• Encouraging lifestyle and diet changes (lower sodium, heart healthy diet).

• Inform patients on risks of smoking.

Nursing Interventions:

• Regularly check blood pressure. Normal is 100-120/60-80 mmHg.

• Check heart rate.

• Adhere to strict I&O to monitor fluid.

• Listen to heart sounds. Arrhythmia? Heart murmurs?

• Check EKG and labs (troponin).

What are some interventions for patients with respiratory conditions?

For Patient Comfort:

• Encourage incentive spirometry.

• Teach deep breathing.

• Encourage coughing to remove excess secretions.

• Promote adequate fluid intake.

• Use nasal cannula or supplemental O2 for low oxygen levels.

• Maintain an upright position to open airways.

Nursing Interventions:

• Regularly check blood oxygen.

• Count respirations. Normal is 12-20.

• Listen to lung sounds. Are there crackles? Wheezing? Stridor?

• Check breathing depth and accessory muscle usage.

• Inspect skin integrity and color (especially cyanosis).

• Check ABG (labs).

What is the biggest risk for adverse effects of medication in older adults, and why?

Older adults are the highest consumers of medications (polypharmacy). 90% of people 65+ use one or more prescription drugs, with a majority taking at least one OTC medication or supplement.

Polypharmacy (using 5+ medications daily) contributes to adverse effects, but also falls, cognitive impairment, incontinence, disability, loss of function, and mortality (geriatric syndromes). The risk of harm increases with each prescription (after 3.5 medications) which contributes to adverse drug events. Most adverse effects are preventable.

What is the prescribing cascade?

When side effects of a medication are misinterpreted as a new condition, causing more medications to be prescribed. This is a preventable cause of polypharmacy, which can be avoided through nonpharmacologic interventions, medication assessments, and regimen lists.

Polypharmacy is the most common cause for ADEs in older adults.

What is the most important prevention for polypharmacy in older adults? What can be done to prevent it?

Medication reconciliation. This is when we check medications to see if they are necessary for the patient after each visit. What are they still taking? Is this a part of a prescribing cascade? Can we treat something non-pharmacologically?

“Most medication errors stem from a lack of communication during transitions of care.”

Prescribers should coordinate to get a better “picture,” nurses should overlook the necessity of medications, and patients should be educated on adverse effects, effects from missing dosages, and proper medication names.

What is the difference between absorption, distribution, metabolism, and elimination?

Absorption: Ability for meds to enter bloodstream. In older adults, blood flow and gastric acid decreases, which lowers absorption.

Distribution: Ability for meds to enter tissues. Older adults have more fat, removing lipid-soluble medications slower. Also less body water, removing water-soluble medications faster. Hypoalbuminemia is more common, leading to higher serum levels.

Metabolism: When enzymes process and modify medications (usually liver). Less blood flow and less mass in liver leads to slower metabolism.

Elimination: Drugs leave the body (usually kidney). Slower excretion in older adults leads to slower elimination.

What is the Beers Criteria?

Medications that may need to be reconsidered (not discontinued) in older adults (65+). This is due to adverse effects more common for this population, as well as drug-drug interactions. It may be inappropriate to prescribe medications on this list depending on the patient’s presentation. There are alternative drugs listed as well.

What is the process of deprescribing?

Identifying, discontinuing, or reducing the dosages of medications. It’s always best to follow the therapeutic objective we learned in pharm, or weighing the benefits and harms of taking a drug. Nurses should recognize ADE’s and communicate with prescribers regarding the appropriateness of a patient’s drug regimen based on their condition.

What are some interventions patients can do in order to better adhere to their medications?

• Use the brown bag method. Bring every medication bottle to an appointment and discuss the necessity of the medications, as well as gather education. How do these meds help my health conditions?

• Manage medications through alarms, calendars, large-print labels, pill organizers, and regular healthcare appointments. How can I help with my own adherence?

• Implement medication goals with the prescriber to hopefully lower the dosage over time. How can I assess my symptoms over time?

What are some signs to look out for when determining the atypical presentations of disease?

Communicate with families and caregivers to achieve an accurate baseline for:

• Changes in behavior, like anxiety, confusion, aggression, disruption.

• Changes in appetite, like anorexia and weight loss.

• Changes in functioning, like self-neglect, altered functional ability, incontinence, falls.

• Changes in presentation and vitals, like difficulty breathing, arrhythmia.

What puts patients at higher risks of having atypical presentations of disease?

1. Patients with comorbidities and co-occurring conditions may be more likely to present atypically.

2. Patients undergoing polypharmacy are at higher risks of ADE's, and thus also atypical presentations.

3. Patients that have cognitive and/or functional impairments make it difficult to recognize typical signs. Pay attention to vitals and non-verbal cues.

4. Age itself is a risk due to the fact that many older adults present with very different symptoms for the same condition than younger adults.

How does pneumonia, MI, UTI, and infection present differently in older adults?

• Pneumonia can present as a lack of cough and chest pain, fatigue, lack of appetite, and confusion.

• MI can present as a lack of chest pain, confusion, weakness, and dizziness.

• UTI can present as confusion, lack of appetite, and incontinence. Voiding may have no pain.

• Infection can present as only slightly elevated temperature and WBC count, no tachycardia.

What is asymptomatic bacteriuria? How should it be treated?

When there is bacteria in urine, but there are no symptoms of UTI. This happens when a urine culture comes back as positive without any other symptoms, which happens more often in patients with dementia and incontinence. Higher incidence among women and older adults in LTC.

This is temporary and does not require treatment in most cases. Tests can come back negative within 30 days. The harm outweighs the benefit when taking antibiotics long-term because this condition often doesn’t last long. Antibiotics contribute to drug-resistant infections (C. diff, MRSA).

What are the 5 signs of geriatric syndromes?

1. Falls.

2. Urinary Incontinence.

3. Delirium.

4. Pressure Ulcers.

5. Functional Decline.

What causes falls in older adults?

• Difficulty with balance, gait, and mobility.

• Chronic conditions, like diabetes, heart conditions, stroke, etc. can affect mobility and sensation.

• Having difficulties with vision can make avoiding obstacles more difficult.

• Incontinence leads to older adults rushing to the restroom, which is more dangerous at night.

• Cognitive decline or impairment increases fall risk due to reduced awareness.

• Low orthostatic hypertension from conditions or polypharmacy can cause dizziness and falls from position changes.

What are some of the ways that we can prevent falls?

1. Assistive devices: Augi camera, bed alarms, gait belts, hoyers, walkers, etc.

2. Home enhancements: Secured rugs and cords, lowered beds, remove tripping hazards, improve lighting, grab bars in the shower, elevated toilet seats, non-slip mats, stair lighting, proper footwear.

3. Managing health conditions: Regular eye exams, managing medications, light exercise (if possible). Hire a dog walker!

How is orthostatic blood pressure measured?

Check for a change in 20 mmHg systolic and 10 mmHg diastolic:

1. Have the patient lie down for at least 5 minutes, and monitor the blood pressure.

2. Have the patient sit up or stand, and monitor the blood pressure.

3. Have the patient continue standing for 3 minutes, and monitor the blood pressure one last time.

If a patient feels dizzy or lightheaded, have them lay back down prior to rising again.

What are the 4 main types on incontinence? Provide examples of each. Are they all treatable?

1. Stress Incontinence: Loss of urine from activities that put pressure on the abdomen, which in turn puts pressure on the pelvic floor. Coughing and laughing are examples. Kegels can manage this.

2. Urge Incontinence: Urine leaves the bladder due to strong, unexpected urges from involuntary bladder contractions. Voiding schedules can manage this.

3. Overflow Incontinence: Involuntary loss of urine from a distended bladder, or from an obstruction (like BPH).

4. Functional Incontinence: When functional conditions like arthritis or other conditions limit movement, making it difficult to void in time.

What is peripheral venous disease (PVD)? What are the symptoms, and how is it treated?

PVD: Circulation does not allow blood from the extremities to circulate back into the heart, resulting in venous pumps being overloaded with blood. This is often due to blood clotting or valvular malformations.

• Asymptomatic, non-painful.

• Warm skin (from blood pooling).

• Swelling on both sides of the body (edema).

• Weeping, “wet” ulcers.

Treatment: Rest, elevation, compression socks, and anticoagulants. Anything that allows blood to flow better back to the heart.

What is peripheral arterial disease (PAD)? What are the symptoms, and how is it treated?

PAD: The narrowing of the arteries, resulting in less oxygen reaching the extremities. This can also happen due to atherosclerosis or other conditions.

• Painful due to hypoxia.

• Cold or cyanotic skin.

• Dry, scaly, pale skin and ulcerations from lack of perfusion.

• Diminished or absent pulses (less CO).

Treatment: Exercise, positioning, ceasing smoking, angioplasty, medication. Anything that allows for better circulation.

What are the four stages of the Braden Scale?

1. Stage 1: Redness around the site with no penetration.

2. Stage 2: Minor penetration into the dermis.

3. Stage 3: Exposure of fat.

4. Stage 4: Exposure of muscle, tendon, or bone.

Moisture, sensory impairment, activity, mobility, nutrition, and friction are all factors that can impact Braden scores.

What is the Katz Index? What does it measure?

The Katz Index is a tool used to show the ability for someone to perform activities of daily living (ADLs).

This measures the ability for patients to participate in feeding, continence, transfers, and self-care. These metrics determine the level independence for a patient when participating in routine care activities.

This should be done over time to be compared to previous metrics.

What is the Lawton Scale? What does it measure?

The Lawton Scale is a tool that measures the ability for someone to perform instrumental activities of daily living (IADL).

This measures the ability for patients to use the phone, shop, prep food, upkeep laundry, access transportation, and manage medications and finances. These are skills that are used to manage daily life that may not be essential for survival, but are necessary for true independence.

This should be done over time to be compared to previous metrics.

What are some types of screening tools used for older adults?

1. Depression: Geriatric Depression Scale.

2. Cognition: MMSE.

3. Functional Status: Katz and Lawton Scales.

What is the get up and go test?

This is a test used to measure a person’s mobility. The patient should be able to stand up from an armchair, walk 10 feet, and return to the chair in under 15 seconds.

What are the four and 5 “M’s” in nursing?

The four M’s are what matters, medication, mentation, and mobility. This allows caregivers to assess the need for a medication based on extenuating factors. Are we caring for the whole person? Using screening tools? Are we making sure they are functional and safe? Is the medication appropriate?

The five M’s are mind, mobility, multicomplexity, medications, and matters most. This is a more general overview of the four M’s, but with added assessments outside of medications specifically. This includes regular vitals, screenings, assessments, changes in body systems, medication reconciliation, and monitoring our approach as healthcare workers.

How is the drug rapamycin slowing and reversing aging?

Rapamycin is a medication that inhibits mTOR. mTOR is a nutrient signaling pathway, which decreases over time. By inhibiting this mechanism, we can increase lifespan by another 30 years. This mechanism slows or reverses aging in major organs in the immune system as well.

What are the 7 hallmarks of aging, and how do they happen?

1. Genome Instability, Telomere Shortening, and Epigenetic Alterations: Damage to DNA over time leads to inflammation and damage. This alters telomere shortening, leading to cells dying, and epigeetic alterations, which are DNA modifications that become unstable over time.

2. Loss of Proteostasis: The ability for proteins to function without folding, which becomes damaged over time.

3. Deregulated Nutrient Signaling: These are the most important pathways for aging; they become overactivated over time.

4. Mitochondrial Dysfunction: Proteins fold more and become damaged.

5. Cellular Senescence: Cells that do not function anymore, but also don’t die.

6. Stem Cell Exhaustion: Stem cells decline over time, leading to the phenotype of aging.

7. Altered Cell-Cell communication: without proper communication between cells, they don’t work as efficiently.