nursing 344 - older adults

functional ability

ability to perform activities necessary to live in society

functional status

• ability to perform self-care

• not static = stages of independence and disability

functional assessment

completed in systemic manner through observation + self-reports

functional assessment parts

• activities of daily living (adl)

• instrumental activities of daily living (adls)

• mobility

when do physical changes begin?

many age-related changes begin after 30

immune system

• less effective as we age

• ask pt about vaccines → should get flu and pneumonia vaccine

what signs of infection should we look out for the elderly?

• confusion

• falls

• incontinence

what can you do as nurse to help with vision?

• font 14 + avoid glossy paper

• leave lots of white space on handouts

• devices with larger + fewer buttons

age related abnormalities of eye

• glaucoma

• macular degeneration

• diabetic retinopathy

• retinal detachment

hearing changes for elderly

• loud noises poorly tolerated

• higher pitch sounds not heard

what can you do as a nurse to help with hearing loss?

• speak in a clear + distinct voice

• face them + minimize background noise

drugs

• liver + kidney may lose ability to filter + excrete drugs → monitor for toxicity

• advice pt → make all healthcare workers aware of meds + supplements

tactile

• decreased sensitivity to pain + temp

• diabetes and peripheral vascular diseases impair it further

how to help elderly with tactile issues?

• testing bath water with thermometer

• performing foot inspections

skin changes

• sweat glands diminish

• more sensitive to cold + heat

• needs frequent position changes and good skin care for defense

skin related diseases

solar lentigines and degenerative joint disease

cardiovascular changes

• cardiac output to diminish

• atherosclerosis (hardening of arteries)

• heart less responsive to normal mechanisms

common heart diseases

• hypertension + orthostatic hypotension

• coronary heart disease (heart attacks + angina)

• dysrhythmias

pulmonary changes

• easier to get pneumonia but harder to cure

• ambulate and aspirate patients asap

early signs for breathing problems

• restlessness, mental status changes

• increased respiratory rate

• increased work of breath

neurologic changes

• intelligence does not increase with age

• most elderly are not depressed or confused

normal aging changes for neurological

• decreased short-term memory and attention span

• longer reaction and process time

interventions for neurological changes

• avoid rushing to allow time for processing

• repeat patient teaching

• involve family, if pt allows

digestive changes

• problems increases with age → provide smaller meals

• including: diverticulosis, constipation, diarrhea, hernia, dentition issues (dental)

what to do when you have reflux or hiatal hernia?

elevate head of the bed

renal + urologic changes

• decreased nephrons and gfr

• decreased epo + aldosterone

• incontinence and incomplete emptying

what is the goal of a geriatric assessment?

• identify strengths and limitations

• so appropriate interventions can prevent functional decline

katz index of independence in adl

• activities assessed as independent or dependent

• advantage vs limitations

instrumental activities of daily living

designed as self-report, observations of tasks, or proxy/surrogate report

lawton instrumental activities of daily living

• determine most suitable living situation for older adult

• self-report instrument

when does depression risk increase?

with presence of comorbidity (two or more diseases at once)

geriatric depression scale

• >5: suggests depression + follow-up appt for comprehensive assessment

• >10: depression

caregiver assessment

• most older adults live with informal support

• caregiving linked to satisfaction and stress

• need for institutionalization predicted better by caregiver than illness