GERO CHAPTERS 4-6

OBJECTIVES

1) Differentiate normal aging from pathology

2) Importance of identifying age-related risks affecting safety and function

3) Apply nursing priorities to older adults

GROWING OLDER ADULT POPULATION

  • Importance of Gerontological Nursing

    • most % of your patients will be older adults, making it essential to understand their unique health challenges and how to best advocate for their care.

    • Higher risk for health complications in older adults

    • Nurses play a crucial role in driving patient outcomes

    • safety, function, and quality of life

LIFE TRANSITIONS & PSYCHOSOCIAL AGING

  • Key factors in psychosocial aging:

    • Ageism: systemic discrimination based on age

      • can negatively impact care when older adults are stereotyped

    • Changes due to parenting and grandparenting

    • Changes in family roles

      • can be positive for some but can affect many people negatively

    • Loss of spouse and retirement leading to a shrinking social world, increasing loneliness

      • affects finances and mental health

    • Encountering integrity vs despair during life review and tapping into inner resources

      • increases a risk for functional decline

AGEISM & HEALTH OUTCOMES

  • Impact of stereotypes on care provided to older adults

  • Under-treatment and misattribution of symptoms

  • Advocacy role of nursing to combat ageism in healthcare

MAJOR LIFE TRANSITIONS IN AGING

  • Retirement affecting social dynamics

    • can be positive, but can also lead to loss of routine, purpose, income, and social interaction

      • impacts patients mental health and overall wellbeing

  • Loss and changes in roles

    • loss of spouse, friends, independence, and shifts in family roles

      • increase vulnerability to depression, anxiety, social isolation

  • Reduction in the size of social networks

    • as mobility decreases and friends start to die off, loneliness starts to become more common.

      • more social elderly patients = better outcome

PSYCHOSOCIAL AGING: INTEGRITY VS DESPAIR

  • Life review as a process for meaning-making in aging

    • look back on relationships, accomplishments

      • they find a sense of integrity correlated to peace and pride

  • Development of resilience through life experiences

    • if they look back in regret, they find a sense of despair instead

AGING & ILLNESS

  • Recognition that changes in health increase vulnerability

  • Distinction between normal aging and pathological conditions; pathology is not inevitable

NORMAL AGING VS PATHOLOGY (CORE PHYSIOLOGIC CHANGES)

→ AGE DOES NOT MEAN DISEASE AND ILLNESS IS PROMINENT

  • Changes increase vulnerability

  • Pathology is not inevitable

NORMAL AGING:

  • Immune System Changes:

    • Immunosenescence leads to decreased immune response

      • older adults have a weaker immune system

    • Higher risk of infections due to age-related changes

  • Respiratory Changes:

    • Increase in infection risk due to decreased lung elasticity

  • Cardiovascular Changes:

    • Orthostatic hypotension due to aging physiological changes

  • Musculoskeletal Changes:

    • Sarcopenia associated with decreased muscle mass and increased fall risk

      • weakness, hormone imbalance, higher risk for fall and injury

  • Sensory Changes:

    • Safety and social isolation concerns due to declining sensory functions

      • affects social interaction and fall risk

  • Thermoregulation Changes:

    • Increased risk of hypothermia due to impaired thermoregulation

      • makes it hard for patients to maintain body temp. increases risk for hypothermia

PHYSICAL APPEARANCE CHANGES

  • Aging physical characteristics:

    • Graying and thinning hair, ectropion of eyelids, elongated ears, thicker hair in ears/nose

    • Darkening/wrinkling of skin, arcus senilis, growth of facial hair in women

    • Changes in physical stature: decreased height, deepening hollows of axillae, diminished muscle mass, and skinfold thickness

  • gait = how someone walks

    • men have wider gait, while women have a narrower

IMMUNE AGING (IMMUNOSENESCENCE)

  • Decreased immune response contributes to higher infection risk

    • higher risk for = pneumonia, UTI’s, sepsis

  • Blunted symptoms can complicate diagnosis and treatments

RESPIRATORY & CARDIOVASCULAR CHANGES

  • aging: decrease in lung elasticity

  • Effects on oxygenation and perfusion:

    • Reduced lung elasticity and cardiac reserve result in complications

    • Strategies to mitigate risks of orthostatic hypotension and resultant injuries

      • orthostatic hypotension: significantly increases fall risk

MUSCULOSKELETAL CHANGES: MOBILITY & FALLS

  • Conditions impacting mobility:

    • Sarcopenia leads to a risk of falls due to decreased balance

    • leading cause of injury = falls

      • loss of independence

      • very often preventable

      • prioritize safety interventions

SENSORY & NEUROLOGIC CHANGES: SAFETY & COMMUNICATION

  • Visually and hearing-related declines impacting communication and safety

  • Slower cognitive processing increases risks

  • COMMUNICATION!

    • speak clearly and confirm their understanding, especially with medications

  • assess carefully before making assumptions

THERMOREGULATION & SKIN CHANGES

  • Aging leads to less effective temperature regulation

    • slightest elevation can signal illness

    • temperature problems can lead to death because heat response is altered due to the sweat glands being diminished

  • Increased risk of skin integrity issues such as pressure injuries due to fragile skin

    • less subcutaneuos fat and reduces the cushioning and circulation

      • higher risk for pressure injuries, especially when mobility is limited

→ gentler handling, maintaining good room temp (75), reposition more regularly, keep them dry

  • skin breakdowns are not normal aging

  • older adults can be hypothermic without shivering

NERVOUS SYSTEM CHANGES

  • Changes in brain and nervous system:

    • Decline in weight and blood flow, affecting brain function

    • Slower response to balance shifts, decreased conduction velocity

      • higher risk for falls

    • hypothalamus becomes less effective at temp regulation

    • Altered sleep patterns and frequent awakenings

      • increases risk for delirium

      • make sure you encourage good sleep practices

ENDOCRINE SYSTEM CHANGES

  • Decreased activity of thyroid gland, reduced ACTH secretion

    • affects body’s stress response and body’s ability to maintain homeostasis

    • ACTH levels rise in response to stress, so stress response gets blunted in older adults

  • Insulin release becomes delayed, glucose metabolism is impaired

    • impaired glucose tolerance

  • Reduced gonadal hormone secretion, influencing health in older adults

CHANGES TO THE MIND: PERSONALITY

  • personality remains consistent

    • no single personality type defines an older adult

  • Psychological influences on aging:

    • Changes correlated with general health, genetics, education, activities, and physical/social changes

  • Consistent personality traits maintained unless influenced by diseases or major life changes

→ positive social interventions can maintain positivity

MEMORY CHANGES

  • Types of memory affected by aging:

    • Short-term, episodic, semantic, and working memory

      • short term: small amounts of information; declines with age

      • episodic memory: recalling recent experiences

      • semantic: general knowledge; well preserved w aging

      • working: ability to hold and manipulate in real time (mental math); tends to gradually decline with age

    • Distinction between age-related forgetfulness and memory deficits due to cognitive impairments

      • want to assess for reversible factors

FEATURE COMPARISONS

  • Normal Aging vs Disease/Disorders

    • Normal Aging: Gradual onset, mostly intact attention, mild forgetfulness with slower recall, minor orientation lapses, logical processing

    • Dementia: Slow, progressive decline, mostly intact early stages but declines in later stages, greater short-term memory challenges, disorientation over time, irreversible

    • Delirium: Acute onset, fluctuating attention, worse at night, disorganized, caused by treatable conditions (e.g., infections, medications)

      • medical emergency

    • Depression: Gradual onset resembling dementia, treatment can reverse symptoms, influences cognitive focus and positive attitude

CHANGES TO THE MIND: INTELLIGENCE AND LEARNING

  • Basic intelligence generally stable with maintenance of crystallized intelligence but may decline in fluid intelligence

  • fluid intelligence may decline

    • think abstractly and adapt to new information

    • decisioning remains strong even though problem solving may weaken

  • Learning abilities remain intact with preference for relating new information to past knowledge

  • older adults need repeated exposure in order to retain that information

    • learn better when they can relate new concepts to what they already know

ATTENTION SPAN CHANGES

  • Diminished vigilance, increased distractibility, and difficulties in multitasking noted

  • older adults have difficulty sustaining attention over long periods

    • affect driving, tasks that require ongoing monitoring

    • background noises, multiple conversations can interfere with their focus

    • multitasking can become much more difficult as well

NURSING IMPLICATIONS OF AGE-RELATED CHANGES

  • Understanding age-related changes critical for nursing practice

  • Focus on emphasizing capabilities and assets of older adults

NURSING ACTIONS RELATED TO AGE-RELATED CHANGES

  1. Prevent dehydration and ensuring proper temperature regulation to maintain comfort

  2. Encourage prescribed medication adherence and establish a toileting schedule

    1. prevents UTI’s

  3. Promote safety measures to prevent falls and manage physical exertion and rest periods


  • drug metabolism

    • kidney or liver

KEY RISK PATTERNS

  • Common patterns include:

    • FALLS

      • age-related challenges, balance, any mobility change should go back to fall risk interventions

    • INFECTION

    • MEDICATION TOXICITY   

      • metabolism, renal clearance, presents a bigger risk for adverse effects

    • FUNCTIONAL DECLINE

      • ADL’s

NURSING ASSESSMENT PRIORITIES

  • Evaluate functional changes and assess subtle cues that indicate risks

    • pay attention to changes that are often overlooked

  • FUNCTION BEFORE DIAGNOSIS

CLINICAL REASONING IN OLDER ADULTS

  • Identifying risks: Changes from baseline in mobility, cognitive status, intake and symptoms can indicate issues

  • Prioritize patient safety and functional capabilities over everything else

CASE EXAMPLES AND QUESTIONS

  • Questions based on scenarios:

    • Assess an 81-year-old presenting with weakness and confusion

    • Prioritize assessment of an older adult with new confusion and decreased mobility

    • Assess risks for falls, infections, and other complications

MEDICATION CONSIDERATIONS AND NURSING GOALS

  • Be aware of polypharmacy risks, altered drug metabolism, and potential adverse effects

  • Ensure nursing goals focus on safety, pain management, and preserving mobility

  • Even standard doses can lead to medication toxicity

PROMOTING MOBILITY

  • Importance of early movement and collaboration with physical therapy for optimal patient outcomes

INFECTION PREVENTION STRATEGIES

  • Essential measures include vaccinations, early recognition of symptoms, and patient education

  • confusion without fever = infection

PATIENT EMPOWERMENT

  • Facilitating older adults' autonomy and allowing them to partake in their care decisions promotes self-care and empowerment

GERONTOLOGICAL NURSING ROLES

  • Advocating, educating, and coordinating care for older adults

FINAL TAKEAWAYS

  • Aging process leads to increased vulnerability, not an inevitable decline in health

    • aging does not lead to disease

  • The proactive role of nurses in preventing complications and taking early action can save lives.


  • if unsure of an answer, choose whatever protects patient safety