Aging and Geriatric Care: Skin, Musculoskeletal, Sensory, Cardiovascular, Respiratory, GI, Urinary, Immune, Nutrition, Sleep, Pain, Medication, Grief, Hospice, Elder Abuse, Fall Prevention

What are common skin changes with aging?

Wrinkling, sagging, loss of elasticity, dry/fragile skin, thicker nails, bruising, skin tears, pressure sores, and liver spots.

Why are older adults at greater risk for skin tears and bruising?

Their skin becomes dry, fragile, and less elastic.

What should be done for dry, fragile skin?

Use good lubricating lotion and bathe less often.

What protects older adults from UV damage?

Sunscreen and regular skin checks.

What musculoskeletal changes occur with aging?

Loss of flexibility, decreased muscle mass/strength/endurance, arthritis, unsteady gait, loss of bone density, and increased fracture risk.

What is kyphosis?

A hunchback or 'dowager's hump' associated with osteoporosis.

What type of exercise helps maintain bone health?

Weight-bearing exercise.

What does ambulating mean?

Walking.

What nervous system changes occur with aging?

Loss of nerve cells, slower nerve conduction, slower reaction time, slower learning, slower pain perception, and decreased cerebral circulation.

Why are older adults at increased risk for falls?

Loss of balance, vertigo, slower reaction time, and other nervous system changes.

What is presbyopia?

Farsightedness caused by diminished adjustment of the lens.

What happens with cataracts?

The lens becomes cloudy.

What happens with glaucoma?

Intraocular pressure increases.

What is presbycusis?

Age-related hearing loss.

What causes hearing loss with presbycusis?

Loss of auditory hair cells and changes involving the ossicles.

What happens to taste and smell with aging?

They may diminish, causing decreased appetite and poor nutrition.

What cardiovascular changes occur with aging?

Thick/hardened heart valves, dilated aorta, weak myocardial muscle, and reduced blood-vessel elasticity.

What can thickened and hardened heart valves cause?

Inadequate pumping of blood and heart murmurs.

What respiratory changes occur with aging?

Decreased elasticity, weaker thoracic muscles, decreased air exchange, and increased retained secretions.

Why are older adults at increased risk for respiratory infections?

Drier mucous membranes and retained secretions increase the risk.

What happens to the trachea with aging?

It stiffens, making effective coughing more difficult.

What GI changes occur with aging?

Decreased taste, tongue atrophy, decreased saliva, receding gums, decreased peristalsis, and decreased nutrient absorption.

Is losing teeth a normal part of aging?

No.

What is presbyesophagus?

Age-related weakening of the esophageal lining that increases the risk of indigestion and aspiration.

Why is constipation common in older adults?

Decreased peristalsis, decreased activity, and decreased sensory perception.

What urinary changes occur with aging?

Urinary frequency, nocturia, urinary retention, decreased kidney blood flow, and incontinence.

What causes urinary frequency?

Bladder hypertrophy decreases the bladder's ability to expand and store urine.

What is nocturia?

The need to urinate during the night.

What can cause urinary retention?

Nerve damage or weaker muscles that decrease the ability to completely empty the bladder.

Why is urinary retention concerning?

It places the client at high risk for a UTI.

What happens to kidney blood flow with aging?

It decreases and can affect the ability to eliminate drugs.

What immune changes occur with aging?

Diminished T-cell and B-cell production/function and decreased resistance to infection.

What happens to autoimmune disease risk with aging?

It increases because the ability to distinguish 'self' from other decreases.

What do carbohydrates provide?

Energy.

What are proteins?

The building blocks of every cell; they repair tissue and help with fluid balance.

What is fiber's main function?

Preventing constipation.

What do vitamins do?

Help regulate body processes and produce chemical reactions in the body.

What do minerals do?

Build bones and teeth, maintain muscle tone, regulate body processes, and maintain acid-base balance.

Why do older adults generally need fewer calories?

Lower activity level and slower metabolism decrease caloric needs.

Why can nutrient absorption decrease with aging?

There is a decreased ability to absorb nutrients.

What can decreased calcium absorption contribute to?

Osteoporosis.

Why might older adults have difficulty eating?

Poor dentition, poorly fitting dentures, decreased saliva, decreased swallowing ability, and decreased taste.

Approximately what percentage of body weight is water?

About 60%.

What is intracellular fluid?

Water inside the cells.

What is extracellular fluid?

Water outside the cells.

What are causes of water loss?

Sweating, respiration, urination, diarrhea, bleeding/surgery, and wounds.

Why are older adults at increased risk for dehydration?

Reduced thirst sensation, fear of incontinence, lack of accessible fluids, inability to obtain fluids, confusion/dementia, and GI distress.

What foods are recommended for indigestion or food intolerance?

Broiled, baked, or boiled foods; avoid fried foods.

What position should a client be in during and after meals?

High Fowler's during and for 30 minutes after meals.

What is anorexia?

Loss of appetite.

What interventions can help with anorexia?

High-calorie foods, frequent small meals, activity, social programs, and tube feeding if needed.

What is dysphagia?

Difficulty chewing and/or swallowing.

What is the main goal when caring for a client with dysphagia?

Reduce the risk of choking and aspiration.

What position should a client with dysphagia use when eating?

High Fowler's, about 90 degrees.

What diets may be used for dysphagia?

Mechanical soft, pureed, and thickened liquids.

What causes constipation in older adults?

Slower peristalsis, inactivity, medications, poor fluid intake, and inadequate fiber.

How can constipation be prevented?

Fluids, fiber-rich foods, physical activity, bowel programs, and prescribed laxatives/stool softeners.

What is insomnia?

Difficulty falling asleep, staying asleep, or waking prematurely.

What is phase advance?

Falling asleep earlier in the evening and awakening earlier in the morning.

What is restless leg syndrome?

An uncontrollable urge to move the legs when lying down, often with uncomfortable sensations.

What is sleep apnea?

At least 5 episodes of not breathing lasting about 10 seconds during sleep.

What is sleep latency?

The delay in the onset of sleep.

What are nonpharmacological ways to promote sleep?

Regular sleep/wake routine, exercise, sunlight, limiting naps/caffeine, toileting before bed, comfortable temperature, reduced electronics, and stress management.

What is acute pain?

Abrupt-onset pain lasting less than 6 months.

What is chronic pain?

Discomfort lasting longer than 6 months.

What is neuropathic pain?

Pain caused by abnormal processing of stimuli by the nervous system.

What is nociceptive pain?

The normal transmission and interpretation of pain.

What is referred pain?

Pain that originates in one area but is felt in another area.

What is intractable pain?

Untreatable chronic pain that resists therapeutic interventions.

Is pain subjective?

Yes. Pain is what the patient says it is, even when signs and symptoms are not present.

What should be documented after a pain intervention?

Pain level, pain description, action taken, and response to the intervention.

What is polypharmacy?

Use of multiple medications.

Why is polypharmacy a concern?

It can cause adverse reactions and medication interactions.

What medication interactions should be assessed?

Drug-drug, drug-food, and drug-herb interactions.

What should the nurse assess before medication administration?

Reason for the drug, appropriate dose, allergies, interactions, special instructions, and route.

What are the stages of Kubler-Ross grief and loss?

Denial, anger, bargaining, depression, and acceptance.

What is denial?

Shock and disbelief, often followed by isolation.

What is anger?

Rage or acting out physically or verbally.

What is bargaining?

Guilt and developing awareness of the diagnosis.

What is depression?

Grief, sadness, and loneliness.

What is acceptance?

Self-reliance and feelings of peace.

What are examples of advance directives?

Living will, durable medical power of attorney, DNR/MOLST, and health care proxy.

What is hospice nursing?

Care for terminally ill clients that emphasizes pain relief and quality of life.

What four areas does hospice focus on?

Physical, psychological/emotional, social/cultural, and spiritual needs.

What is the most important factor in promoting comfort in hospice?

Maintaining a patent airway.

What are common opioid side effects near the end of life?

Sedation/drowsiness, lower blood pressure, decreased respirations, and constipation.

What medication can be used for opioid overdose?

Narcan.

What is compassion fatigue?

A natural reaction to stress that can make a caregiver unable to continue caring for the client.

What is respite care?

Giving a caregiver a break, usually from 1 day to 4 weeks.

What is elder abuse?

Physical, emotional, sexual abuse, exploitation, neglect, or abandonment.

What are signs of possible elder abuse?

Unexplained bruising/injuries, malnutrition/dehydration, untreated wounds, depression/withdrawal, poor hygiene, unsafe living conditions, and inappropriate medication use.

What is the nurse's responsibility regarding suspected elder abuse?

The nurse is a mandated reporter and must report suspected or actual abuse.

What are important fall-prevention interventions?

Keep the bed low, environment clutter-free, provide good lighting, assist with transfers, and keep needed items within reach.

What is the safest approach to restraints?

Avoid them when possible; use them only as a last resort, from least restrictive to most restrictive.