Ch 24- Older Adults

Older adult age group

65 years and older

Full Social Security retirement age

67 years

Trends in older adults

Living longer, working longer, aging in place

Biggest health care cost period

Last 7 years of life

Medicare eligibility

Begins at age 65

Health promotion in older adults

Beneficial at any age

Biggest challenge in geriatric care

Distinguishing normal aging from pathology

Prevalence of chronic disease in older adults

Over 50% have limitations in daily activities

Factors affecting health behaviors

Self-perception, culture, income, access to care

Genomic testing purpose

Provides insight into aging and disease risk

Primary nursing screening priorities

Kidney function, polypharmacy, alcohol/drug use

Other geriatric screenings

Physical activity, nutrition, social support, cognition

Common living arrangement

Aging in place

Grandparent role changes

Caregiver, support role, or primary guardian

Grandparent caregiver stress

Increased physical, emotional, and financial burden

Theories of aging - biological

Cellular death, neuroendocrine decline, longevity genes

Programmed theory of aging

Cells are genetically programmed to age and die

Neuroendocrine theory

Hormonal regulation declines with age

Theories of aging - sociological

Activity, disengagement, role, subculture theories

Activity theory

Staying active leads to higher life satisfaction

Disengagement theory

Gradual withdrawal from roles and activities

Role theory

Adaptation to changing life roles

Subculture theory

Older adults form social groups with shared norms

Developmental theories of aging

Peck, Havighurst, Erikson, Levinson, Vaillant

Erikson stage

Ego integrity vs despair

Ego integrity

Acceptance of one's life with satisfaction and meaning

Despair

Regret, bitterness, dissatisfaction with life

Life review therapy

Structured reflection on life experiences

Health promotion focus

Maintain independence and quality of life

Activities to promote cognitive health

Games, reading, social interaction, learning new skills

Geriatric assessment goals

Maintain function, independence, safety

Activities of daily living (ADLs)

Bathing, dressing, eating, toileting, mobility

Nutrition risks in older adults

Living alone, low income, isolation, poor access

Malnutrition statistics

35-50% in LTC; ~65% hospitalized

Physiologic nutrition changes

Decreased saliva, appetite, absorption

Oral health impact

Poor dentition reduces intake

Obesity prevalence in older adults

~40%

Obesity paradox

Higher BMI (25-27) may be protective in older adults

Mini Nutritional Assessment

Tool to identify malnutrition risk

Constipation causes

Low fiber, fluids, medications, decreased motility

Incontinence prevalence

Affects ~50% of older adults

Stress incontinence

Leakage with coughing, sneezing, laughing

Urge incontinence

Sudden need to void, inability to delay

Overflow incontinence

Incomplete bladder emptying, common with BPH

UTI presentation in older adults

Confusion, mood changes, fever

Physical activity recommendations

Aerobic + strength training

Benefits of exercise

Improved sleep, BP, glucose, balance, mood

Exercise snacking

Short bouts of activity throughout the day

Sleep problems prevalence

~50% report sleep difficulty

Sleep apnea prevalence

20-40% of older adults

Restless leg syndrome

Uncomfortable leg sensations relieved by movement

Sleep promotion strategies

Regular routine, limit caffeine, avoid naps

Pittsburgh Sleep Quality Index

Tool to assess sleep quality

Normal cognitive aging

Slower processing speed

What is NOT normal aging

Dementia or severe memory loss

Delirium

Acute, temporary confusion

Postoperative cognitive dysfunction

Temporary cognitive decline after anesthesia

Dementia definition

Progressive cognitive disorder, not normal aging

Most common dementia

Alzheimer's disease

Alzheimer's symptoms

Memory loss, disorientation, sleep changes

Best dementia management

Nonpharmacologic strategies first

Presbyopia

Loss of near vision

Glaucoma

Increased intraocular pressure

Presbycusis

Age-related hearing loss

Skin changes

Thinner, fragile, decreased elasticity

Pressure injury risk

Increased due to immobility and skin changes

Self-perception influences

Health, culture, family, environment

Reminiscence therapy

Sharing memories to improve mood and cognition

Roles and relationship changes

Loss of work role, increased family reliance

Retirement challenges

Income loss, identity change, loneliness

Predictors of successful retirement

Health, income, social support, optimism

Sexual activity in older adults

Often continues into late life

STI risk in older adults

Increasing, underrecognized

Safe sex education importance

Many did not receive earlier education

Coping with aging losses

Grief, adaptation, finding meaning

Depression risk

Increased with chronic illness and pain

Suicide risk highest group

Men over 75

Positive coping mechanisms

Social engagement, purpose, spirituality

Accident risks

Falls, driving, heat and cold exposure

Heat safety

Fans, hydration, avoid >90°F

Cold safety

Hypothermia prevention, warm clothing

Driving safety

Senior driving courses recommended

Vaccines for older adults

Influenza yearly, pneumococcal

Cancer screenings

Breast, colorectal, prostate, lung (risk-based)

Prostate cancer screening

PSA and digital rectal exam

Polypharmacy definition

Use of 5 or more medications

Common polypharmacy drugs

Diuretics, NSAIDs, anticoagulants, antidiabetics

Polypharmacy risks

Drug interactions, renal impairment

Alcohol use prevalence

~17% of older adults

Hospice care definition

End-of-life care when curative treatment stops

Hospice locations

Home, hospice facility, nursing home

Retirement satisfaction predictors

Health, finances, social engagement