NURS 310 - Comprehensive Geriatric Nursing: Aging, Risks, and Care Strategies

What is successful aging?

remaining physically, psychologically, and socially engaged in meaningful ways defined by the individual. It includes less disease/disability, high cognitive and physical function, active social engagement, life satisfaction, positive self-perception, and comfortable acceptance of impending death.

SATA: What are common age-related changes in older adults?

Sensory: presbyopia, presbycusis, decreased taste, smell, and touch.

Skin: decreased collagen, elasticity, and sweating; increased heat susceptibility.

Cardiovascular: enlarged heart chambers, less elastic valves/arteries, SA-node fibrosis, loss of pacemaker cells.

Autonomic: orthostatic hypotension.

Respiratory: decreased lung elasticity and cough reflex.

Musculoskeletal: muscle atrophy, decreased bone mass/density, sarcopenia.

Endocrine: decreased glucose tolerance.

GI: delayed gastric emptying, decreased peristalsis, impaired drug metabolism, decreased liver size/function.

GU: decreased nephrons/GFR, decreased bladder tone, decreased sex hormones, enlarged prostate.

Immune: immunosenescence.

SATA: What are positive functional consequences according to the Functional Consequences Theory?

Positive functional consequences are outcomes that help the older adult maintain the highest possible level of function despite age-related changes. Examples include maintaining independence, physical and cognitive function, social engagement, meaningful activity, adapting successfully to aging, and maintaining life satisfaction.

What is polypharmacy, and how can adverse effects be reduced?

Polypharmacy is the use of multiple medications. Reduce adverse effects by reviewing the entire medication list, including OTC and herbal drugs; checking the Beers list; confirming each medication has an indication; considering alternatives; monitoring creatinine clearance/labs; checking drug-disease interactions; teaching the patient; minimizing the number of medications; and following "start low, go slow."

What factors increase fall risk in older adults?

Intrinsic risks: orthostatic hypotension, medications causing dizziness/drowsiness, diuretics, antihypertensives, antipsychotics, impaired balance, neuropathy, urinary urgency/incontinence, vision impairment, and infection such as UTI. Extrinsic risks: unsafe environment, restraints, bedrails, poor supervision, unsafe clothing, and wet/waxed floors.

What should a nurse do when an older adult is a victim of or suspected of elder abuse?

Assess the older adult for injuries, nutrition/hydration, frailty, ADLs, psychosocial status, support resources, and environment; protect the older adult's safety; document objective findings; and report suspected abuse to Adult Protective Services according to policy/law.

What are the types of elder abuse?

Physical abuse, neglect, psychological/emotional abuse, exploitation, abandonment, sexual abuse, and self-neglect.

What is ageism?

Ageism is stereotyping, discrimination, and prejudice against someone based solely on age.

What is a geriatric syndrome?

A geriatric syndrome is a clinical condition or group of symptoms common in older adults that does not fit neatly into one disease category, is usually multifactorial, is associated with multiple comorbidities and poor outcomes, and requires a multidimensional approach.

What is the goal of gerontological nursing?

To promote health, longevity, and independence at the highest level of functioning possible.

What is disengagement theory?

a sociological theory stating that older adults gradually withdraw from society and relationships as they age in order to maintain equilibrium.

Does depression in late life cause a positive or negative functional outcome?

Negative functional outcome. Older adults with depression, especially when combined with chronic illness, have more serious negative functional consequences.

SATA: What are negative functional consequences of smoking?

contributes to repeated bodily injury over time under the Wear-and-Tear Theory. It therefore contributes to poorer physical functioning and unsuccessful aging.

What indicates Erikson's ego integrity in an older adult?

Ego integrity is shown when the older adult accepts their life and past experiences, feels their life had meaning and value, and can accept aging and approaching death rather than experiencing regret or despair.

What is the medical term for age-related hearing loss?

Presbycusis.

SATA: What are atypical grief responses in older adults?

Physical symptoms, immobilization, insomnia, decreased appetite, and worsening/reappearance of pre-existing illness.

What is the Wear-and-Tear Theory?

A stochastic biological theory stating that aging occurs because of repeated use and injury to the body over time. Examples listed include smoking, poor diet, and substance use.

What are the ANA standards/concepts of gerontological nursing?

Recognize the interrelationship of cultural, spiritual, economic, psychological, and biological factors; multiplicity of losses; need for grief work; atypical responses to disease and treatment; accumulated disabling effects of multiple chronic illnesses; and cultural values/social attitudes toward older adults. Gerontological nurses provide evidence-based, person-centered care addressing physical, psychosocial, spiritual, and other needs.

What are common characteristics of geriatric syndromes?

They are highly prevalent in older adults, multifactorial, associated with multiple comorbidities, associated with poor outcomes, often do not fit a single disease category, and require a multidimensional/interdisciplinary approach.

What is functional incontinence?

occurs when the bladder and urinary system function normally, but physical, cognitive, or environmental barriers prevent the person from reaching or using the toilet. Example: a person with dementia cannot recognize or locate the bathroom.

What are causes of delirium?

Infection, medications, withdrawal, undertreatment of pain, fluid/electrolyte imbalance, hypoxia, trauma, and surgery/anesthesia.

What is the difference between delirium and dementia?

Delirium has an acute onset, fluctuating course, altered level of consciousness, and is potentially reversible when the underlying cause is treated. Dementia is chronic and progressive rather than sudden and fluctuating.

What is delirium superimposed on dementia?

An acute episode of delirium occurring in a patient who already has dementia. A sudden change from the patient's usual dementia baseline should make the nurse suspect delirium and search for an acute underlying cause.

What type of loss causes the most profound grief in older adults?

Loss of a spouse/widowhood.

What intervention or tool can nurses use when they notice grief in an older adult?

Life review/reminiscing. Nurses can also connect the older adult with support systems and provide information and choices to counteract powerlessness.

What is elder abuse?

Elder abuse/mistreatment is harmful treatment of an older adult through abuse, neglect, exploitation, abandonment, or other behaviors that threaten the older adult's safety or well-being. It is often considered a "hidden phenomenon."

What is the most common type of elder abuse according to the PowerPoint?

Psychological/emotional abuse.

What communication techniques should nurses use with older adults?

Ask permission to take notes; use a well-lit room with little glare; decrease background noise; use a low-pitched voice; do not shout, mumble, or speak too quickly; face the client directly; speak clearly at a moderate pace; interview the client alone when appropriate; address the client by their preferred name/title; use an unhurried manner; and focus on the main concern first.

What strategies reduce drug-drug interactions in older adults taking multiple medications?

Review all medications regularly, including OTC and herbal drugs; minimize unnecessary medications; check the Beers list; confirm indications; consider safer alternatives; monitor renal function/labs; consider drug-disease interactions; teach the patient; and use "start low, go slow."

What are fall risk factors and how are falls evaluated?

Risk factors include orthostatic hypotension, medications, impaired balance, neuropathy, incontinence/urgency, vision impairment, infection, and unsafe environments. Evaluate falls using SPLATT: Symptom at time of fall, Prior history of falls, Location, Activity, Time, Trauma. Also assess cardiovascular, neurologic, and musculoskeletal systems, orthostatic BP, arrhythmias, strength, gait/balance, medications, and TUG. TUG greater than 12 seconds indicates increased fall risk.

SATA: What assessment findings may be seen in a depressed older adult?

Withdrawal/loss of interest in pleasurable activities, somatic preoccupation, insomnia, poor appetite/anorexia, weight loss, agitation, anhedonia, "I don't know" answers, and suicide attempts. The Geriatric Depression Scale can be used to assess depression.