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9/10 The Aging Population

The Aging Population

  • Gerontologic Nursing overview based on the provided transcript (NUR 131 - Adult Gerontological Nursing).

FOUNDATIONS OF AGING

  • Gerontology: combined biologic, psychological, sociologic study of older adults within their environment.

  • Geriatrics: focuses on physiology, pathology, diagnosis, management of disorders, and diseases of older adults.

  • Gerontologic/geriatric nursing: nursing process applied to older adults in all environments, including acute, intermediate, skilled care, and in the community.

Learning Objectives

  • Define aging and differentiate myths vs. facts.

  • Describe demographics and characteristics of older adults.

  • Explain theories of aging and physiologic changes.

  • Apply Nursing Process, Maslow, and CJMM to gerontological care.

  • Recognize ethical and legal issues in aging care.

  • Analyze NCLEX-style case scenarios for clinical application.

  • Analyze.

Demographics of Aging

  • 65+ population now > 16\% of U.S. population; will reach 20\% by 2030.

  • Life expectancy: 1900 \rightarrow 47\text{ yrs}; Today \rightarrow 78.6\text{ yrs}.

  • 85^+ population expected to double by 2040.

  • Gender & racial disparities persist in life expectancy.

Myths & Ageism

  • Aging = inevitable decline (False).

  • Most older adults are dependent (False).

  • Cognitive decline is universal (False).

  • Nurses must challenge ageism and advocate for accurate views.

  • Discussion: How might ageism impact patient care?

FRAMEWORKS FOR UNDERSTANDING AGING

(Overview: frameworks used to analyze aging across biological, sociologic, psychological, and nursing perspectives.)

Theories of Aging

  • Biological: Stochastic (random damage) vs. Nonstochastic (programmed).

  • Sociologic: Disengagement, Activity, Continuity theories.

  • Psychological: Erikson, Peck, Gerotranscendence.

  • Nursing: Functional Consequences, Thriving, Successful Aging.

Common Aging Changes

  • Cardiovascular: ↓ cardiac output, ↑ BP, valve stiffness.

  • Respiratory: ↓ vital capacity, ↑ infection risk.

  • Musculoskeletal: bone loss, sarcopenia, kyphosis.

  • Nervous: slower reflexes, balance issues.

  • Sensory: presbyopia, presbycusis, ↓ taste/smell.

  • Integumentary: thinner skin, ↓ elasticity, ↑ injury risk.

  • Discussion: Which system changes most affect safety in daily living?

Detailed Common Aging Changes (Expanded)

  • Cardiovascular:

    • Decreased cardiac output → Myocardial hypertrophy.

    • Reduced stroke volume → Increased fibrosis.

    • Calcium and fat deposits → hypertension and increased workload.

    • Slower heart recovery rate to stress.

    • Orthostatic hypotension.

  • Respiratory:

    • Age-related changes may be subtle and gradual.

    • Decreased respiratory efficiency, maximal inspiratory & expiratory force, lung mass & residual volume.

    • Smoking is the most significant risk factor.

  • Musculoskeletal:

    • Alterations in bone remodeling, bone density, muscle strength/size, muscle fibers and cell membranes, and joint cartilage.

  • Nervous:

    • Homeostasis difficult to maintain; nerve cells—small loss of brain mass; slower nerve conduction; confusion with physical illness; loss of environmental cues; cerebral circulation affecting balance.

  • Sensory:

    • Vision: presbyopia, glare intolerance, difficulty adjusting to light changes, trouble distinguishing colors; Macular degeneration is a primary cause of vision loss.

    • Hearing: high-frequency hearing loss.

    • Taste and smell: decreased ability.

  • Integumentary:

    • Epidermal proliferation? (likely epidermal thinning) and dermis becomes thinner. Elastic fibers and collagen become stiffer. Subcutaneous fat decreases → less heat conservation.

    • Loss of resiliency with wrinkling & sagging of the skin. Hair pigmentation changes; balding may occur.

  • Reproductive: Sexual activity tends to decrease due to widowhood and health/medication factors; female changes include vaginal narrowing, elasticity changes, secretions, involution, tone; male changes include less firm testes but potential continued sperm viability to around age 90, with decreased testosterone production.

  • Genitourinary:

    • Filtration rate and tubular function with less efficiency in reabsorption & concentrating urine; slower acid–base balance restoration after stress.

    • Male: BPH; Female: relaxed perineal muscles, detrusor instability (urge incontinence), urethral dysfunction (stress incontinence).

  • Gastrointestinal:

    • Changes in thirst, smell, taste, and salivation.

    • Difficulty chewing and swallowing; delayed esophageal/gastric emptying; reduced gastric acid and pepsin secretion; reduced GI motility.

  • Nutritional Health:

    • Need calories and nutrient-rich, healthy diet; reduce fat intake while ensuring sufficient protein, vitamins, minerals, and dietary fiber; attention to financial constraints and physical limitations affecting shopping/preparation.

  • Sleep:

    • Factors affecting sleep: respiratory problems, Restless leg syndrome, nocturia, pain, dementia, cognitive decline.

    • Effects: increased falls risk, daytime fatigue, reduced physical/mental health, reduced quality of life, poor ICU outcomes.

  • Discussion: Which system changes most affect safety in daily living? (reiterated)

Functional vs Chronological Age

  • Chronological: number of years lived.

  • Functional: physical, psychological, social performance.

  • Nursing focus: function & independence > age.

  • 93% live in the community; 2.3% reside in nursing homes;

    • Live at home or with family, continuing care retirement communities, assisted living facilities, long-term care facilities.

Psychosocial Aspects

  • Ageism; Fear of aging; Negative images in society.

  • Stress and Coping.

  • Common stressors:

    • Normal aging changes impair physical function, activities, and appearance.

    • Disabilities from injury or chronic illness.

    • Social and environmental losses related to income decreases.

    • Decreased ability to perform previous roles and activities.

    • Death of significant others.

  • Coping:

    • Abilities to adapt to change, make decisions, and respond predictably are influenced by past experiences.

    • Often fewer choices and diminished resources to deal with stressful events.

    • Many rely on families and spiritual beliefs for comfort.

Health Promotion & Prevention

  • Encourage lifelong healthy behaviors.

  • Screenings: BP, cancer, vision, hearing, depression.

  • Vaccines: flu, pneumonia, shingles, COVID-19.

  • Nutrition, exercise, sleep, fall prevention.

  • Community-based support services.

GERONTOLOGIC NURSING MANAGEMENT

  • Nursing Management goals:

    • Supporting cognitive function.

    • Promote physical safety.

    • Promote independence in self-care activities.

    • Reduce anxiety and agitation.

    • Improving communication.

  • Further nursing management:

    • Providing socialization and intimacy needs.

    • Promote adequate nutrition.

    • Promote balanced activity and rest.

    • Support home, community-based, and transitional care.

Pharmacologic Aspects

  • Polypharmacy: administration of multiple medications concurrently; common in older adults with several chronic illnesses.

  • Aging changes alter drug pharmacokinetics:

    • Absorption, metabolism, distribution, excretion.

  • Discussion: What would you assess first in an older adult admitted after a fall?

Polypharmacy & Medication Safety

  • Risks: interactions, adverse effects, nonadherence.

  • Medication reconciliation & compliance strategies.

    • Discussion: What real-world safety risks come with polypharmacy?

      The discussion should explore how multiple medications can lead to increased risks of drug interactions, potentially causing serious adverse effects, particularly in older adults, who may have age-related physiological changes affecting drug metabolism and excretion like diminished liver and kidney function. Additionally, nonadherence may complicate treatment further, leading to unintended consequences that could jeopardize patient safety.

Nursing Implications

  • Medication dosing adjustments; \"start low, go slow\".

  • Assess knowledge of medications and usage.

  • Review need for medications; coordinate with prescribers.

  • Factors affecting compliance include:

    • Complex medication regimens that may overwhelm patients

    • Side effects that discourage adherence

    • Financial constraints impacting the ability to afford medications

    • Lack of understanding regarding medication purpose and dosages

    • Cognitive decline that affects memory and routine

  • Keep medication regimen simple.

  • Strategies to improve compliance.

    • Question: If a patient is on multiple medications, what are some things the nurse can do to ensure safety?

      To ensure safety when a patient is on multiple medications, the nurse can:

      • Conduct a thorough medication review to identify potential interactions.

      • Provide education on the importance of adhering to the regimen and the effects of missing doses.

      • Simplify the medication schedule by coordinating dosages to minimize the number of times medications need to be taken each day.

      • Encourage the use of pill organizers to help the patient keep track of their medications.

      • Schedule regular follow-up appointments to monitor adherence and address any issues that arise.

      • Asking why theyre on medications

Mental Health Concerns in Older Adults

  • Depression: Most common.

  • Increased risk for suicide (suicidal ideation).

  • Substance misuse.

Geriatric Syndromes

  • Geriatric triad: cognitive changes, falls, incontinence.

  • Impaired mobility.

  • Dizziness.

  • Falls and falling.

  • Urinary incontinence.

  • Increased susceptibility to infection.

  • Altered pain and febrile responses.

  • Altered emotional impact.

  • Altered systemic response.

ETHICS & PROFESSIONAL STANDARDS & Elder Abuse & Neglect

  • Types: physical, emotional, psychosocial, sexual, financial, abandonment.

  • Signs: unexplained injuries, withdrawal, poor hygiene, fear.

  • Nurses are mandated reporters.

  • Early recognition & intervention essential for safety.

Potential Economic Effects

  • Social

  • Health care

  • Home health services

  • Costs of aging care

  • Hospice services aka end of life care

  • Aging with a disability

APPLICATION: NCLEX CASE STUDY

  • Case Study: Mrs. R, 82 years old

    • Widowed, lives alone

    • History: HTN, osteoarthritis, recent fall

    • Current: confusion, dizziness, poor nutrition, polypharmacy

    • Difficulty managing ADLs

    • Nurse must identify priorities using CJMM + Maslow + Nursing Process

NCLEX Q1: Recognize Cues

  • Which findings are MOST concerning? (Select all that apply)

    • A) Confusion

    • B) Dizziness

    • C) Arthritis pain

    • D) Polypharmacy

    • E) Lives alone

Answer Q1

  • Correct: A, B, D

    • Confusion + dizziness = immediate safety concerns.

    • Polypharmacy increases risk for adverse effects.

    • Arthritis pain and living alone are important but not urgent.

NCLEX Q2: Prioritize Hypotheses

  • Which nursing diagnosis is priority?

    • A) Risk for falls r/t dizziness and weakness

    • B) Impaired social interaction r/t isolation

    • C) Chronic pain r/t arthritis

    • D) Risk for imbalanced nutrition r/t living alone

Answer Q2

  • Correct: A

    • Maslow: safety (fall risk) > psychosocial or chronic issues.

    • Physiological and safety needs must be met first.

NCLEX Q3: Take Action

  • Which intervention is MOST appropriate immediately?

    • A) Review medications with provider

    • B) Refer to senior community center

    • C) Provide fall-prevention teaching & safe environment

    • D) Encourage activity for arthritis symptoms

Answer Q3

  • Correct: C

    • Safety = immediate priority.

    • Medication review and socialization important but secondary.

    • Teaching must address urgent fall risk first.

NCLEX Q4: Evaluate Outcomes

  • Which outcome BEST indicates effective nursing care?

    • A) Patient ambulates safely without assistance

    • B) Patient attends community exercise class

    • C) Patient verbalizes improved mood

    • D) Patient reports reduced arthritis pain

Answer Q4

  • Correct: A

    • Safe ambulation addresses immediate safety & independence.

    • Psychosocial and chronic issues are important but secondary.

Wrap-Up & Key Points

  • Aging population growing – need for gerontological nurses.

  • Myths must be challenged; promote realistic views.

  • Nurses apply ADPIE, Maslow, and CJMM in care.

  • Prioritize physiological & safety needs first.

  • Polypharmacy, chronic illness, elder abuse = major concerns.

  • Advocacy and NCLEX-style reasoning essential.

  • Discussion: What is ONE key thing you’ll carry into practice about caring for older adults?

References

  • Eliopoulos, C. (2022). Gerontological Nursing (10th ed.). Wolters Kluwer.

  • Fries, J. F. (1980). Aging, natural death, and compression of morbidity. NEJM, 303(3), 130–135.

  • Hinkle, J. L., & Cheever, K. H. (2021). Brunner & Suddarth’s Textbook of Medical- Surgical Nursing (15th ed.). Wolters Kluwer.

  • NCSBN. (2019). Next Generation NCLEX Project: Clinical Judgment Model.

  • U.S. Census Bureau. (2023). Older Population and Aging.

  • World Health Organization. (2006). Constitution of the World Health Organization.