Gerontology Final Exam Review

Older Adult Age Categories: Baby Boomers

60-69 years old

Older Adult Age Categories: In-between

70-99 years old

Older Adult Categories: Centenraians

100-110 years old

Older Adult Age Categories: Super Centenarians

110 years old and over

Comprehensive Assessment of Older Adults Includes

Complexity related to care of older adults , Interprofessional approach , Peron,and family-centered approach to care , Shared decision making

What is the focus of a comprehensive assessment of older adults?

The focus is to improve quality of life and overall health and function

Define Activities of Daily Living (ADLs)

Activities of daily living are activities usually performed in the course of a normal day such as ambulation, eating, dressing, bathing, and grooming.

Define Instrumental activities of daily living (IADLs)

Instrumental activities of daily living are activities necessary for independent living such as doing the laundry, driving, cooking, managing finances, answering the telephone, and traveling outside of walking distance

Normals changes with older adults: Skin

Wrinkling, dryness, turgor sluggish, and delayed healing Decreased sub-Q tissue and fat pad protection Thinning of the hair, finer, loss of pigmentation

Abnormal changes with older adults: Skin Abnormal

skin tugor -tenting, skin cancer, cellulitis, and pressure injuries

Normal Changes with Older Adults: Pulmonary

Elastic recoil due to stiffening of the chest wall and increased resistance in airflow Residual capacity increase with the diminished inspiratory and, expiratory muscle strength of the thorax, More effort required for movement of the diaphragm, Lower efficiency of gas exchange and reduced avility to handle secretion

Normal Changes with Older Adults: Skeletal

Kyphoscoliosis or arthritic costovertebral joints , Osteroporosis

Normal Changes with Older Adults

Cardiac S3 and S4 sounds are heard, Hypertrophy of the myocardium, sclerosis, stenosis of the valves, decreased pacemaker cells, and fibrosis of the AV node

Normal changes with Older Adults Gastrointestinal

Weakened, lower espohageal sphincter may lead to GERD, decrease size in liver and pancreas, Decreased peristalsis may lead to constipation (increased risk for hemorrhoids)

Normal changes with Older Aults Genitourinary

Kidney atrophy and may have scclerois with age which decreases blood flow, Increased noctural urination, Constipation and dehyration may increase risk of UTI , Begnign prostatic Hyptertophy present

Abormal Changes of Older Adults: Eyes

Over 20/40 need corrective lenses, diabetic retinopathy (blood flow to the retina is cut off, casuing tissue to die and blindness), cataracts (cloudiness of lens), macular degeneration, and galucoma

Abnormal Changes of Older Adults: Ears

Loss of ability to hear high frequncy sounds (presbycusis caused by a weakened cochlea) Weber and Rinne test

Abnormal Changes with Older Adults Touch

Touch should NOT diminish unless that patient has diabetes

Age Friendly Health System

Initiative of The John A. Hartford Foundation and the Institute of Healthcare Improvement in partnership with the American Hospital Association (AHA) and the Catholic Health Association of the United States (CHA)

Aim of Age Friendly Health System

All care with older adults is Age-Friendly, 1. Guided by evidence-based practices: 4Ms, 2.Causes no harms, 3. Is consistent, with What Matters to the older adult and their family

What are the components of the age-friendly health system?

4s, What Matters, medication, Mentation, and Mobility

primary prevention

strategies that can and are used to prevent illness before it occurs (ex: vaccines)

Secondary prevention

Early detection of teh disease or health problem that has developed (ex: health screenings)

Tertiatry Prevention

Addresses the needs of person who have their day-to-day wellness challenged, by slowing disease or limiting complications (ex: rehabilititation and patient education)

Biological Aging

Also known as senescene, a complex genetically regulated interactive process of change in every living organism

Biological Theories of Aging:

Cellular Functioning Changes to cells that decrease ability to replicate attributed to aging, especially the mitochondria (What are some major questions related to aging? What triggers changes at the cellular organ level? Can it be stopped or modulated? Is aging orderly and predictable, or random and chaotic? What is the relationship between epigeetics and environment?)

Telemores and Aging

As a cell divides, the telomeres become shorter and shorter each time until they are gone. At this point, the so-called "real" DNA cannot be copied anymore, and the cell simply ages and is no longer able to replicate itself

What factors may accelerate telomere shortening?

Chronic stress

Pessimism

inter partner violence

long-term caregiving

less than 8 hours of sleep a night

higher body mass index and lack of exercise

History of childhood neglect or adverse events

smoking

major depressive disorder

What can be done to reduce cellular damage?

´Avoid environmental pollutants and unnecessary radiation. (Oxidative stress)

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Watch for research on the use and presence of antioxidants. (Oxidative stress)

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Avoid stress. (Oxidative stress, Immune)

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Minimize the potential for infection: wash hands frequently, undergo immunizations, and avoid those who are ill. (Immune)

role theory

one role is replaced by another one of comparative value

How one adjusts to aging, maintaining self-identity

Socially and culturally constructed expectations of behavior at times in one's life and in pre-established roles

´Popular culture continues to challenge role theory and age norms

´Older adults are assuming roles and behaviors unimagined when role theory was first proposed

Activity Theory

An individual's ability to maintain an active lifestyle leads to healthy aging

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´Continued activity and the ability to "stay young" indicated successful aging

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Attempted to predict and explain how individuals adjusted to age-related changes by looking at one's level of activity and productivity

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Popular because it is consistent with Western society's emphasis on work, wealth, and productivity

Disengagement theory

Withdrawl from roles and activities earlier in life necessary to allow transfer of power to younger generation

Possibly provided the basis for age discrimination

´Challenged socially and legally

Older adult participation is now considered beneficial to society

Continuity Theoy

An individual tends to develop and mainatin conistent pattern of behavior, substituting one role for a similar one as one matures

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Culture

learned values, beliefs, expectations and behaviors of a group of people

Enculturation

cultural beliefs passed down from one generation to another

Acculturation

a process where persons from one culture adapt to another culture

Cultural diversity

the existence of a variety of cultural or ethnic groups within a society.

race

the phenotype as expressed in observable traits such as eye color

ethnicity

refers to the cultural groups with which one self-identifies

Ethnocentrism

the belief that one ethic/ cultural group is superior to that or another

cultural desctructiveness

systemic elimination of recognized culture or another

cultural blindness

perceiving someone based on stereotypes which is not meant to cause any harm

cultural pre-competence

there is awareness and an attempt to improve some aspect of services to a specific population and clinicians are aware of perceptions, values, and other elements of their own culture and of cultures different from their own

cultural competence

the ability to step outside one's biases and accept that others bring a set of values and priorities to the health care setting

Guidelines for working with interpreters

a. Instruct the interpreter to use the person's own words and avoid paraphrasing

b. Instruct the interpreter to avoid inserting his or her own ideas from omitting information

c. Look and speak directly to the person not the interpreter

d. be patient

e. Use short units of speech

f. Use simple terms and avoid medical jargon

g. Listen to the person and watch nonverbal communication (facial expressions, voice intonation, body movements) to learn about emotions regarding a specific topic

h. Clarify person's understanding and accuracy of the interpretation by asking the person to tell you his or her own words what he or she understands

health inequalities

health inequalities are a result of an imbalance in wealth

health disparities

health disparities are the results of differences in health outcomes as a result of ethnicity that refers to the differences in health outcoes between groups

Moving Towrads Cultural Proficiency and Healthy Aging

Become familiar with your own cultural perspectives

Examine your own person and professional behavior for signs of bias and the use of negative stereotypes

Remian open to viewpoints and behaviors that are different from your expectations

Appreciate the ingerent worth of all persons from all groups

Develop the skill of attending to both nonverbal and verbal communication

Develop sensitivity to the clues given by others, indicating paradigm from which they face health illness and aging

Learn to negotiate rather than impose

cultural proficiency

The ability to move smoothly between two worlds for the promotion of health and caring persons

LEARN Model for Cultural

L= Listen to what the patient has to say

E= Explain your perception of the problems

A=Acknowledge the similarities and differences of perception

R= Recommend a plan of action that considers both perspectives

N= Negotiate a plan that is mutually acceptable

Integrating Concepts for Promoting Healthy Aging Include: ´

Challenges and opportunities

Cultural identity is one of the major elements of self-concept and key to self-esteem

Nuclear or extended family is the chief avenue of transmitting cultural values, beliefs, customs, and practices

Spirituality or religiosity plays a major role in defining culture

Consideration for different degrees of assimilation

Nurses are expected to provide culturally proficient care to persons regardless of age, health beliefs, experiences, values, and styles of communication

Obstacles to cross-cultural care include:

a) cultural destructiveness

b) Ethnocentrism

c) Sterotyping

Changes in the Central Nervous System of Older Adults:

Neurons Shrinkage in neuron and dradual decrease in neuron numbers

Structural changes in dendrites

Despoit of lipofuscin granules, neutritic plaque, and neurofibrillary bodies within the cytoplasm and neurons

Changes in the Central Nervous System of Older Adults: Neurotransmitters

´Changes in the precursors necessary for neurotransmitter synthesis

Loss of mylein and decreased conduction in some nerves, especially peripheral nerves (occrs with patient who are diabetics)

Changes in receptor sites

Alteration in the enzymes that synthesize and degrade neurotransmitters

´Significant decreases in neurotransmitters, including acetylcholine (ACh), glutamate, serotonin, dopamine, and γ-aminobutyric acid

Memory

Ability to retain and store information and retreive when needed

What three components make up memory?

Immediate recall

short-term recall

remote/long term recall

Health Literacy

The degree to which an individual has the capacity to obtain, communicate, process, and understand basic health information and services need to make appropriate health decisions

Who is at risk for limited health literacy older adults

those who are poor

people with limited education

refugees, immigrants

persons with limited English proficiency (LEP)

What are the two core prinicpals of the national action plan to improve health literacy?

All people have the right to health information that helps them make informed decsions

Health services shoud be delivered in ways that are easy to understand and that improve health, longevity, and quality of life

Ageism

Stereotyping and discriminating against people due to age

Elderspeak

A condescending way of speaking to older adults that resembles baby talk, with simple and short sentences, exaggerated emphasis, repetition, and a slower rate and a higher pitch than used in normal speech.

Elderspeak may be characterized by:

1\. simplistic vocabulary and grammar

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2. shortended sentences
3. slowed speech
4. elevated pitch and volume
5. inappropriate terms of endearment - sweetie, baby
6. speaking as if person is not there
7. using familiar/informal communication without permission
8. using the "royal we" - "how are we doing today?"

How to provide theraupetic communication with older adults?

Attentive listening

Authentic presence

Nonjudgement attitude

Clarifying

Giving Information

Seeking validation and understanding

Keeping focus

Using open-ended questions

Maintaining Eye Contact

Talking slowing, with low frequency voice

Life Stories and Reminiscing

Important for older adulst because research suggests that communication skills training that involves membory book and life review activities with those living with dementia and their families can:Important for older adulst because research suggests that communication skills training that involves membory book and life review activities with those living with dementia and their families can:

\-increase quantity and quality of communication between care receipts and caregivers

\-lower caregiver stress and burden

\-reduce behavioral problems

time slips program

Group members looking at a picture are encouraged to create a story about the picture

Myth about Aging: All elderly individuals have Alzheimer's

Fact: Memory loss is part of the natural aging process, this doesn't mean they have a psychological disease

Myth about aging: Elderly people aren't sexually active

Fact: They are teh highest populations of STD's because they think they don't need sexual health practice because of their age (higher risk in nursing homes)

Myth: All elderly patients are stubborn

Fact: The are used to set enviornments/ routines, they aren't used to change and are sometime sopposed to it. They arent always stubborn, sometimes they are scared or dont understand

Myth about aging: You must talk louder and slower because they are deaf

Fact: While hearing loss is a natural part of aging, not all adults are hard of hearing. Talk slow and pronounced. NOT LOUDER

Special Considerations in the Older Adult Population

Listen patiently

Allow for pauses

Ask questions that are not often asked ( what can you do in a few moths that you can't do now?)

Observe minute details (environment, skin)

Obtain data from all available sources

Recognize normal changes associsated with older adulthood that might be considered abnormal in one who is younger

Areas of Emphasis of ROS for Older Adults: Constitutional

Changes in the level of energy and appeitie

Areas of Emphasis of ROS for Older Adults: Respiratory

SOB and under what circumstances

Frequency of respiratory problems

Need to sleep in chair or elevated pillows

Areas of Emphasis of ROS for Older Adults: Cardiac

Chest, shoulder, jaw pain and under what circumstances

If already taking anginal medication, whether there is need for more dosage

Heart Palpatations

If using anticoagulants is there evidence of brusing or bleeding

Areas of Emphasis of ROS for Older Adults: Vascular

Cramping of Extremities, decreased sensation, edema, what time of day and how much

Change in the color of skin

Areas of Emphasis of ROS for Older Adults: Urinary

Changes in urine stram and for how long

Incontentience and if so, under what circumstances and degree

Areas of Emphasis of ROS for Older Adults: Sexual

Desire and ability to continue physical sexual activity

• Ability to express other forms of intimacy

• Changes with aging that may affect sexuality (e.g., vaginal dryness, erectile dysfunction)

Areas of Emphasis of ROS for Older Adults: Musculoskeletal

Pain in joints, back, or muscles

• Changes in gait and sense of safety in ambulation

If stiffness is present, when is it the worst and is it relieved by activity?

If limited, effect on day-to-day life

Areas of Emphasis of ROS for Older Adults: Neurological

Changes in sensation

Changes in memory other than very minimal

Ability to continue usual cognitive activities

Changes in sense of balance or episodes of dizziness

History of falls, trips, slips

Areas of Emphasis of ROS for Older Adults: GI

Continenece, constipation, bloating, and anorexia

Areas of Emphasis of ROS for Older Adults: Integument

Dryness, frequency of injury, speed of healing

itching, dryness, history of cancer

Considerations of a Physical Assessment: Height and Weight

Monitor for changes in weight.

Weight gain: especially important if the person has any heart disease; be alert for early signs of heart failure.

Weight loss: be alert for indications of malnutrition from dental problems, depression, or cancer. Check for mouth lesions from ill-fitting dentures. There is an increased rate of mortality for rapid weight loss in persons with dementia.

Considerations of a Physial Assessment: Temperature

Even a low-grade fever could be an indication of a serious illness. Temp of 100 may indicate sepsis

Considerations of a Physcial Assessment: Blood Pressure

Positional blood pressure readings should be obtained because of high occurrenec of orthostatic hypotention

Considerations of a Physcial Assessment: Skin

Check for indications os solar damage, espcially among person who worked outdoors or live in sunny slimates. Due to thinning "tenting" is NOT a good indicator of hydration status. Examine bruises

Consideration of a Physical Assessment: Ears

As a result of drying cerumen, impactions are common. These must be removed before hearing can be adequately assessed.

Consideration of a Physical Assessment: Hearing

High-frequency hearing loss (presbycusis) is common. Whisper test of little utility. The person often complains that he or she can hear but not understand because some, but not all, sounds are lost, such as consonants. The person with severe but unrecognized hearing loss may be incorrectly thought to have dementia.

Consideration of a Physical Assessment: Eyes

Reduced pupillary responsiveness (miosis). Normal if equal bilaterally (conduct PERRLA test). Gray ring around the iris (arcus senilis). Sagging of lids. Position of lids

Consideration of a Physical Assessment: Vision

Increased glare sensitivity, decreased contrast sensitivity, and need for more light to see and read. Ensure that waiting rooms, hallways, and exam rooms are adequately lit.

Decreased color discrimination may affect ability to self-administer medications safely.

Consideration of a Physical Assessment: Mouth

Excessive dryness common and exacerbated by many medications. Cannot use mouth moisture to estimate hydration status. Periodontal disease common. Decreased sense of taste. Tooth surface abraded.

Consideration of a Physical Assessment: Neck

Because of loss of Sub- Q fat it may appear that cartoid arteries are enlarged when they are not (assess for JVD)

Consideration of a Physical Assessment: Chest

Any kyphosis (disk decrease will increase the risk of micro breakage) will alter the location of the lobes, making careful assessment more important. Crackles in lower lobes may clear with cough.

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Risk for aspiration pneumonia increased and therefore the importance of the lateral exam and measurement of oxygen saturation

Consideration of a Physical Assessment: Heart

Listen carefully for a third or fourth heart sound. Fourth heart sound is common. Determine if this has been found to be present in the past or is new. Up to 50% of persons have heart murmur.

Consideration of a Physical Assessment: Extremities

Dorsalis pedis and posterior tibial pulses very difficult or impossible to palpate. Must look for other indications of vascular integrity. Edema common but NOT normal due to potential disease process like Chronic heart failure

Consideration of a Physical Assessment: Abdomen

Because of deposition of fat in the abdomen, auscultation of bowel tones may be difficult

Consideration of a Physical Assessment: Neurological

Although there is a gradual decrease in muscle strength, it still should remain equal bilaterally. Greatly diminished or absent ankle jerk (Achilles) tendon reflex is common and normal. Decreased or absent vibratory sense of the lower extremities, testing unnecessary. Slowed reflexes. Coherence, memory. Verbal fluency should be intact.

Consideration of a Physical Assessment: GU Male

Pendulous scrotum with less rugae; smaller penis; thin and graying pubic hair.

Consideration of a Physical Assessment: GU female

Small to nonpalpable ovaries; short, dryer vagina; decreased size of labia and clitoris; sparse pubic hair. Use utmost care with exam to avoid trauma to the tissues.

Geriatric Syndromes

Falls and gait abnormalities

Frality

Delirium

urinary incontinence

sleep disorders

pressure ulcers

Fraility

´Unintentional weight loss: Unintentional weight loss >10 pounds in prior year

´Exhaustion:

Self-report that everything done last week was an effort; couldn't get going