Geriatrics: Journey Across the Lifespan

Geriatrics: Learning Objectives

• Explain how the developmental theories apply to the geriatric person

• Recognize the normal physiologic changes of the geriatric person

• Identify health maintenance concerns for the elderly person

• Discuss the adjustments that a person must make with aging

• Recognize delirium, its causes, and nursing care

• Differentiate between dementia, delirium, and depression

• Recognize the stages of Alzheimer's dementia and the associated nursing cares

Are You Old?

• There is no standard clinical basis for establishing 65 as the dividing line for old and young.

Gerontology

• The study of the normal effects of aging and age-related diseases on the human body.

• Aging is a complex phenomenon that begins with birth and continues throughout the lifespan until death.

• Gerontologists are geriatric specialists in advanced-practice nursing, geriatric psychiatry, medicine, and social services.

Old Age Divisions

• "Young Old": 65 to 74

• "Old": 75 to 90

• "Very Old": 90+

• Old age is best divided into three periods.

Geriatric Developmental Theories

• Objective #1: Explain how the developmental theories apply to the geriatric person

Erik Erikson

• Famous for coining the phrase "Identity crisis."

• The development of identity was one of Erikson's greatest concerns in his own life and in his theory.

• Each stage is marked by a conflict; successful resolution results in a favorable outcome.

• Favorable outcomes are sometimes known as "Virtues."

Erickson's Psychosocial Stages

Childhood
* 1st year of life:
* Crisis: Trust vs. Mistrust
* Favorable Outcome: Faith in the environment and future events
* Unfavorable Outcome: Suspicion, fear of future events
* 2nd year:
* Crisis: Autonomy vs. Doubt
* Favorable Outcome: A sense of self-control and adequacy
* Unfavorable Outcome: Feelings of shame and self-doubt
* 3rd through 5th years:
* Crisis: Initiative vs. Guilt
* Favorable Outcome: Ability to be a "self-starter," to initiate one's own activities
* Unfavorable Outcome: A sense of guilt and inadequacy to be on one's own
* 6th year to puberty:
* Crisis: Industry vs. Inferiority
* Favorable Outcome: Ability to learn how things work, to understand and organize
* Unfavorable Outcome: A sense of inferiority at understanding and organizing

Transition Years
* Adolescence:
* Crisis: Identity vs. Confusion
* Favorable Outcome: Seeing oneself as a unique and integrated person
* Unfavorable Outcome: Confusion over who and what one really is

Adulthood
* Early adulthood:
* Crisis: Intimacy vs. Isolation
* Favorable Outcome: Ability to make commitments to others, to love
* Unfavorable Outcome: Inability to form affectionate relationships
* Middle age:
* Crisis: Generativity vs. Self-absorption
* Favorable Outcome: Concern for family and society in general
* Unfavorable Outcome: Concern only for self—one's own well-being and prosperity
* Aging years:
* Crisis: Integrity vs. Despair
* Favorable Outcome: A sense of integrity and fulfillment; willingness to face death
* Unfavorable Outcome: Dissatisfaction with life; despair over prospect of death

Integrity vs. Despair

• Occurs during old age and is focused on reflecting on life.

  • Despair:

    • Life has been wasted

    • Experience many regrets

    • Feelings of bitterness

  • Integrity:

    • Feel proud of their accomplishments

    • Few regrets

    • General feeling of satisfaction

    • Attain wisdom, even with confronting death

Robert J. Havighurst

• Most famous book: Human Development and Education

• Each human has three sources for developmental tasks:

  1. Tasks that arise from physical maturation

  2. Tasks that arise from personal values

  3. Tasks that have their source in the pressures of society

Six Major Stages in Human Life

• Infancy & early childhood (birth till 6 years old)

• Middle childhood (6 – 12 years old)

• Adolescence (13 – 18 years old)

• Early Adulthood (19 – 29 years old)

• Middle Age (30 – 59 years old)

• Later maturity (60 years old and over)

Developmental Tasks of Older Adults

1.  Adjusting to decreased physical strength and health
2.  Adjusting to retirement and reduced income
3.  Establishing an explicit affiliation with one’s age group
4.  Adjusting to the death of a spouse
5.  Adopting and adapting social roles in a flexible way
6.  Establishing satisfactory physical living arrangements

Biological Theories of Aging

• Clockwork Theory or Programmed Aging Theory

  • Connective tissues have an internal clock that genetically program the length of one's life.

• Free-radical Theory or Somatic Mutation Theory

  • Free radicals in the atmosphere cause breakdown in the aging process.

• Wear-and-Tear (stress theory & cross-linkage or collagen theory)

  • After repeated injury, cells wear out and cease to function.

• Immune-System Failure Theory

  • A decline in the immune functions of the body causes the body to slow.

• Autoimmune Theory

  • Results from the weakening of the immune system, not recognizing the body’s own tissues and destroying itself.

Psychosocial Theories of Aging

• Disengagement Theory

  • Individual and society gradually withdraw from each other.

• Activity Theory

  • Age-related changes that decrease activity must be replaced.

• Continuity-Developmental Theory

  • Personality and coping remain constant with aging.

  • Aging is seen as a part of the life cycle, not as a separate terminal stage.

Physical Changes with Aging

• Objective #2: Recognize the normal psychologic changes of the geriatric person

Height and Weight

• Adults lose 1 cm per decade in height after the age of 30.

• Decrease in shoulder width due to muscle mass loss in the deltoids.

• Head circumference decreases, and the nose and ears lengthen.

• Body weight decreases slowly after age 55.

• Loss of body surface and active cell mass.

• 30% fewer cells than younger adults.

• Atrophy of body fat.

Musculoskeletal System

• Loss of bone mass

• Postural changes

• Decreased height

• Decreased muscle mass and strength

• Ligaments and tendons are less elastic

• Pronounced stiffness and diminished range of motion following periods of disuse

Cardiovascular System

• Cardiac output decreases – 1% per year between ages 20 and 80 results from loss of cardiac muscle strength

• Slower heart rate – the older heart needs more rest between beats

• Heart valves become thicker and more rigid

• Vessels lose elasticity

• Slight increase of the systolic pressure, while the diastolic pressure remains the same related to increased peripheral resistance accumulation of collagen and lipofuscin in the vessels and narrowing of the diameter

Respiratory System

1.  Pulmonary elasticity and ciliary action decrease.
    *   Rate increases, depth of respirations lessens
2.  Alveoli decrease in number, increase in size.
    *   Diminished gas exchange
    *   Vital capacity decreases 1L between age 20 -60
3.  Increased rigidity of chest wall due to calcification
4.  Decreased cough efficiency

All result in increased susceptibility to infections

Gastrointestinal System

• Saliva decreases

  • Results in xerostomia and dysphagia

• Diminished gag reflex

  • Risks of choking

• Decreased peristalsis

  • Delayed emptying of the esophagus, stomach, and lower intestines

  • Constipation and increased flatus

• Decreased gastric secretions

  • Increased indigestion

  • Decreased total stomach capacity

  • Less hunger and appetite

• Decreased nerve sensations

  • Delayed signal to defecate

  • Weakening of the external sphincter

  • Possible bowel incontinence

  • Increase incidence of diverticulitis

• Decreased liver size

• Gallbladder emptying lessens

  • Bile thickening, increased cholesterol content, increased incidence of stones

Genitourinary System

• After menopause, the ovaries, uterus, and fallopian tubes atrophy.

• Vaginal walls become thin and less elastic.

• Lubrication and vaginal secretions decrease.

  • These changes may result in dyspareunia (painful intercourse).

  • Increase risk of vaginal infections.

• Estrogen levels decrease in women.

  • Results in deepening of the voice, thinning pubic hair, and atrophy of breast tissue.

• Gradual decline in testicular mass

• Longer time achieving an erection

• Less semen is released at ejaculation

• Testosterone and sperm levels decrease gradually

• Hypertrophy of the prostate gland

  • Causes difficulty voiding

• Decrease in kidney size and functioning nephrons.

  • 1/3 to 2/3 reduction in filtration rates

  • Decreased renal clearance

• Bladder capacity decreases

  • Results in frequency and nocturia

• Decreased bladder wall elasticity

• Muscle strength decreases in the bladder and the perineal area

  • Results in increased risk for cystitis

• Signal needing to void may be delayed

• Sodium conserving decreases

• BUN increases (creatinine better indicator of kidney function in older people)

• Renal function increases when lying down

Integumentary System

• Skin, hair, nails, and oil and sweat glands

• Loss of skin elasticity

• Skin becomes thinner, drier, and more fragile due to loss of subcutaneous adipose tissue.

  • Prone to skin breakdown, especially following minor bruising or injury

  • Difficulty in maintaining homeostasis

  • Susceptibility to changes in temperature, pressure, moisture, and infection

• Circulatory changes delay wound healing

• Decrease in the number and function of the sweat glands.

  • Perspire less, chill easily

• Decreased amounts of melanocytes as well as an uneven distribution

  • Irregular pigmentation

• Nail growth slows and nails become brittle, dull, and yellow.

• Toenails become thicker.

• Hair grey

  • 50% of individuals at 50 years of age

• Hair loss or thinning (not confined to the head)

  • Begins in the 30’s for men and after menopause for women

• Men have an increase of hair in the eyebrows, nose, and ears.

• Women may have unwanted hairs on the face and chin

• Changes place elderly at risk for skin disorders

Neurological System

• Neurons decrease

  • 5% to 10% atrophy by the age of 70

  • The rate of atrophy increases after 70

  • Decreased capacity to transmit messages to and from the brain

• Brain weight peaks at age 2-25

  • 7% brain mass lost by age 80

• Decreased cerebral blood flow due to changes in the circulatory system

• Slowed motor response

• Slowed reaction time 30% longer in the elderly

• Problems of memory and learning are not related to normal aging

Sensory System

• Taste, sight, hearing, touch, smell

• All senses become less effective as we age

Visual Changes

• Begin in middle age

• Presbyopia: the loss of the ability to focus

• Cataracts: opacity (clouding) of the lens

• Incidence of glaucoma and cataracts increases

• Peripheral vision diminishes

• Sensitivity to glare increases

• Color vision changes as we age

• Red and Yellow

• Distinguishing between green and blue colors diminishes.

• Blockage of the lacrimal ducts (tear ducts)

  • May cause the eyes to water excessively

  • Medications, vitamins, and disease can cause dryness

  • Artificial tears may help (need for 20% more light to see by the age of 40)

Hearing Changes

• Presbycusis: age-related hearing loss

  • At age 10, we hear a high frequency of 20 kHz.

  • By age 50, that frequency decreases to 13 kHz.

  • By 60, little hearing over 5 kHz.

  • It is best to address older people in low –pitched, moderate loud tones to compensate for the loss of high-frequency hearing.

• Thickening of the tympanic membrane

• Calcification of the bones

• Increased cerumen (ear wax)

• Nerve and circulatory changes

  • Increased symptoms of conductive hearing loss such as fullness, itching, and tinnitus result from obstruction or reduction in the passage of sound in the inner ear.

Taste Changes

• Loss in the number of taste buds

• Increased threshold for salt and sugar

• Diminished ability to perceive bitter, salt, and sour tastes

Olfactory Changes

• Diminished sense of smell

Touch Changes

• Decrease in feeling light touch, pain, and temperature changes

Dentition

• Tooth loss is not a consequence of aging.

• Normal aging of the teeth consists of:

  • Natural signs of wear and tear

  • Loss of enamel

  • Lengthening of the tooth

  • Decreased ability to cut and chew efficiently

• Tooth loss is a result of poor care leading to disease.

Endocrine System

• Secretory cells are replaced with connective tissue, decreasing hormone levels.

• All body tissues are affected by these changes in the endocrine system.

• Diabetes mellitus and Thyroid dysfunction are the 2 main endocrine disorders affecting the elderly.

Health Maintenance Concerns for the Elderly Person

• Objective #3: Identify health maintenance concerns for the elderly person

• Homeostasis is defined as a balance between the external and internal environment.

• As the individual ages, common age-related changes make it more difficult for us to maintain this balance.

• The emphasis is no longer solely preventative but is placed in maintenance in the elderly.

• Regular checkups and screenings should be maintained even more as we age to ensure homeostasis.

Examinations and Screenings for the Aging Adult

• Physical exams:

  • Every 3 years to age 40

  • Every year from age 40, or as instructed by your pcp

• Breast Cancer (women)

  • Less frequent in men

  • Self-breast exam monthly

  • Clinical breast exam every 3 years to 40, then every year

  • Yearly mammogram at 40

• Cervical cancer (women)

  • Pelvic exam with a PAP every 3 years.

  • Women who have had hysterectomy with removal of the uterus and cervix do not need PAP unless the hysterectomy was for pre-cancer or cancer.

  • After 65-70 if normal PAP last 3 years and an abnormal test last 10 years, consult with PC about continuing need.

• Prostate (men, beginning age 50)

  • PSA test yearly

  • Digital rectal exam early (begin at age 45 if African-American or family hx of prostate cancer)

• Testicular cancer

  • Self-exam monthly

• Colorectal cancer (men / women, age 50)

  • Fecal occult blood test yearly

  • Sigmoidoscopy or colonoscopy every 3-5 years, depending on polyp size.

• Skin Cancer (men & women)

  • Self-exam monthly

  • Clinical exam yearly

• Oral cancer

  • Yearly as part of dental or medical exam

• Bone density

  • Those at risk: postmenopausal women, maternal hx of hip fx, fx after age 50, tall height at age 25

  • Begin usual testing at age 65

• Vision

  • Yearly exam with glaucoma screening

• Immunizations

  • TD: booster every 10 years 5-7 years if injured should have had ONE booster of Tdap

  • Influenza: 1 dose yearly “high dose vaccine” (contains 4x the antigen as the regular flu shot) results in a higher immune response.

  • Pneumococcal polysaccharide vaccine (PPV): 1 dose, those up to 65, if medically indicated; 1 dose for those unvaccinated by age 65, or received the dose more than 5 years previously (before age 65)

  • Zoster: Recommends two doses of Shingrix separated by 2 to 6 months for immunocompetent adults age 50 years and older. Whether or not they report a prior dose of Zostavax

Prevention in the Elderly

• Factors that may affect or influence an older person’s health may include:

  • Lifestyle

  • Changes in body composition

  • Inflation and fixed incomes

  • Social Situations (living alone or with others)

  • Levels of education

  • Culture

  • Religion

  • Family structure

Dietary Recommendations

• 51-75 men 2000 to 2300 cal./day

• 76+ 1650 to 2000 cal./day

• 51-75 women 1300 to 2200 cal./day

• 76+ 1300 to 1800 cal./day

• 1000 to 1500 mg Ca/daily men and women should have vitamin D with the Ca to facilitate the absorption. (1 cup of milk = 300 mg Ca)

• Carbohydrates: 60% of dietary intake

• Protein: 12-13% daily

• Fats: 30% daily

• Fiber: 25-50 g/day

Osteoporosis “brittle bones”

• Bone mass is decreased because bone is absorbed faster than it is formed.

• Results in a greater risk for fractures.

Two types of osteoporosis

1.  Type I found primarily in women after menopause (thought to be related to lack of estrogen)
2.  Type II occurs in both sexes as a result of aging

Reducing Risk for Osteoporosis

1.  Avoid tobacco
2.  Regular exercise
3.  Avoid caffeine
4.  Limit alcohol
5.  HRT (estrogen)
6.  Increase Ca intake (with D)
7.  Maintain a safe environment (increased risk of fractures with fall)

Risk Factors

*   Family history
*   Inactivity or immobility
*   Low Ca intake (below 80mg/day)
*   High alcohol or caffeine intake
*   Smoking
*   Gastric or small bowel resection
*   Low body weight
*   Long-term use of glucocorticoids or anticonvulsants
*   Hyperparathyroidism (aids in the regulation of Ca absorption)
*   Early menopause
*   Fair skin
*   Female

Encouraging Exercise

• Lack of activity results in physical decline in older individuals.

• What was once accepted as the normal deterioration of old age is now considered disuse.

• Research has shown that high-intensity, progressive resistance training can improve muscle strength and muscle size in the frail older adult.

Benefits of Exercise

• Should be habitual but not unduly strenuous.

• Regular exercise promotes:

  • Cardiorespiratory fitness

  • Reduces the risk for coronary heart disease

  • Builds muscle strength, endurance, and flexibility

  • Lowers blood pressure, blood lipids, and glucose tolerance

  • Enhances well-being and helps reduce the risk of depression

  • Always get permission from the PCP prior to initiating

Hygiene

• Good hygiene and grooming are an important part of older individuals' self-esteem and confidence.

• Adaptations need to be made to accommodate the aging body.

Aging Changes Affecting Nutrition

*   Less aware of thirst sensation, decreased gag reflex
*   Increased threshold for sugar and salt
*   Decreased number of taste buds
*   Decreased ability to discern salty, sweet, bitter
*   Decreased peristalsis, gastric secretions, saliva production
*   Decreased stomach capacity
*   Decreased stomach emptying
*   Diminished sense of smell, taste
*   Increased indigestion, decreased hunger and appetite
*   Need for increased protein intake with illness and/or surgery

Aging Changes Affecting Hygiene

*   Increased skin dryness, decreased elasticity
*   Increased sensitivity to temperature
*   Decreased sense of smell, sight
*   Decreased physical movement
*   Genitourinary changes (bladder and bowel changes)
*   Sweat Glands decrease in size and amount
*   Nails become hard and brittle (care in cutting or trimming)
*   Wear and tear on the teeth
*   Decreased salivation

Aging Changes in Immunity

• The thymus begins to shrink after adolescence (the site T cells mature), T cells do not decrease with age. T cell function decreases.

• The immune system loses its ability to fight off infections as we grow older.

  1. Increases the risk for infection

  2. May make immunizations less effective

• The immune system’s ability to detect and correct cell defects also declines.

• As we age, the immune system also seems to become less tolerant of the body’s own cells (autoimmune).

Management of Chronic Illnesses

• Although illness affects all dimensions of a person regardless of age, older adults deal with a variety of problems.

• Aging is a normal process, and illness is a pathological process, which often occur at the same time.

• The changes of aging and the needs imposed by chronic illness interrelate to increase the risk for problems in all areas of life.

• The probability and possibility of a person becoming ill increases with age.

The most common chronic illnesses in the Elderly are:

*   Adult-onset diabetes
*   Arthritis
*   Kidney and bladder problems
*   Dementia
*   Parkinson’s disease
*   Glaucoma
*   Cataracts
*   Lung disease
*   Osteoporosis
*   Enlarged prostate
*   Macular degeneration
*   Depression
*   Cardiovascular disease
*   Hypertension
*   Any Cancer

• Chronic health problems or disabilities may also result from acute illnesses or accidents.

Elderly Response to Infection

• Diagnosing the elderly with an infection can be difficult.

• Classic symptoms such as fever, chills, and vomiting are less likely.

• What you see:

  • Subnormal temperature

  • Increased pulse rate

  • Unexplained dehydration

  • Confusion

  • Poor appetite

  • Fatigue with increased aches and pains

• For specific infections, you might see:

  • Respiratory infection – cough, increased mucus, abdominal pain, H/A, chest pain, generalized weakness, loss of appetite.

  • Urinary Infection – flank pain, new incontinence, pain & frequency with urination, weakness, blood in urine.

  • Skin Infection – redness, warmth, pain, or tenderness at the site.

Sleep and Rest

• What is Sleep?

  • The central nervous system controls the sleep-wake patterns for all of us.

  • There are two types of sleep: REM and NREM

  • Everyone at any age needs to experience both types every night.

  • There are 5 stages: 4 NREM and 1 REM

  • Personal circadian rhythm - The bodies response to the day-night cycle of the sun

Sleep patterns with age

• As one ages, one tends to sleep less than 8 hours per night.

• Older people have an impaired capacity to maintain sleep.

• Sleep is marked by frequent and prolonged awakenings during the night.

• Stage III and REM sleep diminishes.

• Common to wake earlier, resulting in daytime fatigue from normal changes in the circadian rhythm.

• Sleep deprivation is marked by fatigue, tiredness, diminished coordination and attention span, eye problems, muscle tremor, muscle weakness, apathy, and depression.

Nursing interventions to promote rest

• Meet the individual’s comfort needs:

  • Warm drinks (milk)

  • Back rubs

• Maintain their Routine

• Environmental concerns such as room temperature, noise, and lighting.

• Tend to toileting needs

• Reposition

• Pain needs

• Daytime naps

• Exercise in the early part of the day

• Avoid stimulants (coffee, alcohol, and nicotine)

• Avoid large or heavy meals before bed

• Sleep medications, tranquilizers, and sedatives are commonly used to promote sleep. These should be avoided in the older person.

Abuse

• As elders become more physically frail, they're less able to stand up to bullying and or fight back if attacked.

• More than half a million reports of abuse against elderly Americans are reported every year, millions more go unreported.

Adjustments Associated With Aging

• Objective #4: Discuss the adjustments that a person must make with aging

Work and Leisure

• Many older adults continue to work to postpone retirement because the discontinuation of the work role causes a change in lifelong habits.

• Many individuals' self-worth is directly associated with their work roles.

• The job market continues to show preference to the young worker over the older, more skilled worker.

• The state of the individual's health contributes to the adjustment to retirement.

Decreased Income

• Income is often reduced.

• This can be caused by several changes:

  • The access and cost of health care and medications.

  • Maintenance of the home or travel and leisure activities may have to be canceled.

Physical changes and chronic illnesses

• How we view aging will affect how we cope with our changing bodies.

• Physical appearance has a strong impact on our self-concept.

• Most aging is gradual and allows one time to adjust to the changes.

• Those individuals who cannot cope well may become depressed.

• Physical or emotional illness of either spouse may frequently cause role changes.

Loss of Friends

• Older individuals may lose friends because of death, while others may find it necessary to move to a new community, giving up old friends and neighbors.

• Older adults begin to face the reality of dying as their friends and loved ones die.

Dementia, Delirium & Depression

• Objective #6: Differentiate between dementia, delirium, and depression

• Many factors influence a person’s ability to think clearly.

• Stress and change can cause anyone to have difficulties remembering appointments or to be distracted easily.

• Sometimes physical factors such as illness, high or low blood sugars, or insufficient oxygen can cause a person to act in a bizarre way.

• Individuals who are disoriented are found in every setting and age group. It is not something that only appears in the elderly.

• When an elderly individual becomes disoriented, caregivers may assume incorrectly that this is a normal aging process.

• Clarification of the differences between dementia, delirium, and depression can provide guidance for effective interventions.

Dementia

• Dementia refers to the loss of cognitive abilities.

  • Memory loss, disorientation, and confusion may be caused by over 70 different diseases.

• Alzheimer's disease is just one of these, but it is the most common and the leading cause of dementia in the older age group.

• Only one in eight will develop AD.

• Including a cognitive functioning assessment should become a routine part of your assessment in the older individual.

• Many early-onset dementias are missed because this assessment is not done.

  • 5-10% incidence in 65 years old and older

  • 20-40% incidence in 80 years old and older

Delirium

• Objective #5: Recognize delirium, its causes, and nursing care

• Refers to a situation in which a person has a rapid change in behavior and thinking ability.

• An acute problem which usually inhibits one’s ability to recall where he or she is, time of day, or even their name.

• Short-term memory may or may not be intact. Hallucinations or delusions may be present.

• Usually results from physiological causes and is reversible.

• Those things that may result in delirium are malnutrition, electrolyte imbalance, infection, acid-base imbalance, change in blood glucose, hypoxia, drug reactions, dehydration, and head traumas are the most common.

Depression

• A prolonged feeling of profound sadness and worthlessness

• Surviving losses is a part of the aging process.

• An older person may lose relationships with people dying, retirement, or relocation, or they may lose the ability to maintain contacts with old friends and family because of physical problems

• Is likely the oldest and still one of the most frequently diagnosed psychiatric illnesses.

• More prevalent in men as they age.

• Less prevalent in women as they age.

• Because depression is a part of grieving and loss, it is a serious problem among the elderly.

• Many medications can produce a pseudo depression.

Signs of Depression and Suicidal Thoughts

*   Crying spells
*   Insomnia
*   Eating Disorders
*   Social isolation or withdrawal
*   Acting-out behaviors: school phobias, underachievement, truancy, temper outbursts, substance abuse
*   Feelings of hopelessness
*   Unexplained physical symptoms
*   Loss of interest in appearance
*   Giving away of possessions

Comparisons: dementia, delirium, and depression

Differentiating Between Dementia and Delirium

Ask the following two questions:

• How long has this been going on?

• How abruptly did it start?

Nursing Care of the Delirium

• Determine the cause Because it is reversible care consists of assessing for the systemic , mechanical or psychosocial-environmental cause and reversing it.

• Treat the cause

• The sooner this is done the sooner delirium is resolved.

Nursing Care of the Depressed Patient

• Directions that may aid in the treatment, may consist of:

  • Therapy

  • Exercise

  • Exposure to the sunlight

  • Improving the diet

  • Medications

Alzheimer's Dementia

• Objective #7: Recognize the stages of Alzheimer's dementia and the associated nursing cares

• Alzheimer's is classified as either early onset and genetically linked or the most common type of Alzheimer's, which is not considered genetic.

• The most common type of dementia is AD.

• The only conclusive way to diagnose AD is by autopsy.

Ten Signs of Alzheimer’s

1.  Memory loss that disrupts daily life
2.  Challenges in planning or solving problems
3.  Difficulty in completing familiar tasks at the home, at work or at leisure
4.  Confusion with time or place
5.  Trouble understanding visual images and spatial relationships
6.  New problems with words or writing
7.  Misplacing things and losing the ability to retrace steps
8.  Decreased or poor judgment
9.  Withdrawal from work and social activities
10. Changes in mood and personality

Differences between: Signs of Alzheimer’s

Symptoms of Alzheimer's Disease
* Poor judgment and decision making.
* Inability to manage a budget.
* Losing track of the date or the season.
* Difficulty having a conversation.
* Misplacing things and being unable to retrace steps to find them.
Typical age-related changes
* Making a bad decision once in a while.
* Missing a monthly payment.
* Forgetting which day it is and remembering later.
* Sometimes forgetting which word to use.