Older adults

Life expectancy for men

76 years

Life expectancy for women

81 years

Types of disabilities that can be seen

Hearing

Vision

Cognitive impairment

Ambulation/Mobility/Physical Activity

Self-care/Independent Living

Depression

Strength

Endurance

Nutrition

Sarcopenia

decrease in skeletal muscle mass

Sarcopenia obesity

decreased muscle mass with excessive body fat

Geriatric syndrome

Anorexia

Dementia

Dizziness

Falls

Frailty

Gait Instability

Impaired Cognition

Impaired hearing

Impaired vision

Malnutrition

Parkinson disease

Pressure ulcers

Sleep complaints

Vertigo

Frailty

associated with increasing age, aging is independent of frailty

Most common geriatric syndromes

urinary incontinence, cognitive impairment, pressure injury, falls, polypharmacy, delirium, weight loss

Why may a health history be difficult to obtain?

No social interactions, they want to talk a lot, may have difficulty recalling info, reliability?

What should you establish before starting HH?

LOC, can they hear?, be respectful, proper title, explain what you are doing, what can you get from records?

Prep for assessment

limit noise, be respectful, address by last name, be patient, minimize positional changes

Neurological changes

lose nerve cells, nerve impulses slow

decreased sensations, reflexes, balance

tremors, involuntary movements?

Cognitive decline causes changes in

short term and long term memory

Mini Cog

simple screening tool to identify early mental decline

3 item recall test to assess memory and simple clock drawing test

Cognitive disorders

dementia, alzheimer’s, delirium, depression

Dementia

progressive, irreversible, decline in mental function; memory impairment

Delirium

acute. Reversible state of disorientation and confusion; true medical emergency

Depression

mood disorder marked by a loss of interest /pleasure in living. Common in older adults, but difficult to recognize because of less obvious symptoms

Why is skin turgor not helpful test in older adults

d/t natural wrinkling of skin, won’t be able to properly give accurate

Solar Lentigo

hyperpigmented macular lesions commonly seen on the sun-exposed body surface areas

Cherry hemangiomas

small bright cherry red round spots seen on the trunk and extremities

Seborrheic keratosis

non-cancerous pigmented waxy lesion; color ranges are from light tan, brown, or black

Skin Tags

flesh colored pendulum-like lesions

Cutaneous horn

caused by an overgrowth of keratin

Senile purpura

areas of ruptured fragile capillaries and bruising of the skin

Actinic keratosis

rough, scaly patch that most often develop on chronically sun-exposed areas

Shingles caused by varicella-zoster virus

higher risk d/t immune response decreasing

What can lead to weight loss or affect eating

decreased sense of taste, decreased salvia production, teeth issues, malocclusion of teeth, properly fitted dentures, receded gums

Signs of dysphagia

coughing, drooling, throat clearing, pocketing fluids, liquid foods

Older adults are vulnerable to

malnutrition, inadequate micronutrient intake, sarcopenia

Mini Nutrition Assessment

most validated nutritional screening and assessment tool that can identify geriatric patients aged 65 and above who are malnourished or at risk of malnutrition

6 questions

How common hearing loss?

1/3 of 61-70

80% of 85+

Most common cause of hearing loss in older adults

Cells within the organ of Corti not replaced

Difficulty adapting to darkness can lead to

increased risk of stumbling or falling

Cataracts

opacity and clouding of the lens

Glaucoma

loss of peripheral vision

Macular degeneration

loss of central vision

Amsler grid

assesses central vision 

Abnormal Amsler grid

lines look distorted, broken, or blurred; macular degeneration

Older adults suffer from

constipation d/t decreased motility, activity, fluid intake, fiber, and medications; ask your patient about diet, exercise, medications

Types of incontinence 

stress, urgency, functional, overflow

Stress incontinence

leaking small amounts with intraabdominal pressure; coughing, sneezing, exercising

Urge incontinence

sudden urge to urinate

Overflow incontinence 

caused by weakened bladder muscle or urethral blockage, causing an overflow of urine; incomplete emptying of the bladder

Functional incontinence

unable to control bladder before reaching the bathroom d/t limitations with mobility or cognition

Less dense bones increases risk for

osteoporosis

Osteoarthritis 

the most common type of joint disorder in the world affecting over the age of 65. It is a progressive disease often referred to as “wear and tear arthritis”.

Rheumatoid Arthritis

progressive inflammatory autoimmune disorder that destroys the joints and causes deformity

Osteoporosis

a progressive disease where the bone matrix isn’t replaced by new bone; bone mass and density decrease which can lead to an increased risk for fractures

Kyphosis

“humpback” “hunchback” exaggerated curvature of thoracic spine; problems with posture, gait, and balance

Get up and Go Test

assesses balance, gait, risk for falling, strength

Get up out of chair with arms, walk, turn around walk back, sit back down

<10 secs

If a fall occurs, what do you assess?

ABCs

Hit head?

Vital signs

witnessed/unwitnessed

SPLATT

S - symptoms experience at time of fall

P - previous number of falls

L - location

A - activity engaged in at time of fall

T- time (hour) of fall

T - trauma assoc. with fall

Risk factors for becoming frail 

medical, nutritional, cognitive, activity 

Assess for 3 of 8

1. Unintentional weight loss

2. Decreased activity and engagement

3. Self-reported exhaustion

4. Low energy expenditure

5. Weakness

6. Balance and gait abnormalities

7. Cognitive impairment

8. Slow walking speed

Functional status

ability to care for themselves and meeting essential tasks for daily life

ADLs

Living

Type of living arrangement

Live alone or with someone

Feeling of being safe

Plan for help or emergency medical care

If they drive, ask older adult about

Reading signs

Seeing street markings, cars and people at different times of the day/night.

Handling headlight glare at night

Seeing at night

Getting lost while driving

CAGE questionarie

Assesses for alcoholism

Cut, Annoyed, Guilty, Eye open?

SPICES

assessment/screening tool to alert the nurse to some of the more common nonspecific indicators of disease in older adults

Sleep disorders

Problems with eating & feeding

Incontinence

Confusion

Evidence of falls

Skin breakdown