NUR 252 Healthy Aging – Exam 3 Practice Flashcards

Falls in Older Adults: Risk Factors and Etiology

  • Rationale for High Risk in Older Adults: Older adults are predisposed to falls due to a combination of age-related physiological declines and the prevalence of chronic conditions. Specific factors include:

    • Decrease in muscle strength.

    • Impairment of balance and gait stability.

    • Decreased visual acuity and hearing sensitivity.

    • Slower reaction times.

    • Presence of chronic illnesses that affect overall stability.

  • Physical Internal Factors Contributing to Falls:

    • Weakness in musculature.

    • Unsteady or abnormal gait patterns.

    • Cognitive impairment (e.g., dementia, delirium).

    • Sensory deficits including vision and hearing loss.

    • Hypotension (specifically orthostatic changes).

    • Foot deformities that interfere with proper weight distribution.

    • Sleep disorders leading to daytime fatigue and reduced alertness.

  • Environmental External Factors Contributing to Falls:

    • Inadequate or poor lighting.

    • Presence of clutter, floor rugs, or obstacles.

    • Slippery or wet floor surfaces.

    • Improper bed height (too high or too low for safe transfer).

    • Lack of essential safety features such as grab bars in bathrooms.

    • Unsafe or poorly fitting footwear.

    • Incorrect use or maintenance of assistive devices (e.g., walkers, canes).

  • Medication Factors and Polypharmacy:

    • Polypharmacy Definition: The use of ≥5\geq 5 medications simultaneously.

    • High-Risk Medication Classes:

      • Sedatives and hypnotics.

      • NSAIDS

      • Alcohol.

      • Antidepressants.

      • Opioids.

      • Anticholinergics.

      • Diuretics (due to urgency and potential for dehydration).

      • Antihypertensives (risk of hypotension).

      • Anticoagulants (increases risk of severe injury/bleeding if a fall occurs).

  • Consequences of Falls:

    • Hip Fractures: $95\%$ of all hip fractures are caused by falls.

    • Traumatic Brain Injury (TBI): Significant risk for older adults, particularly those on anticoagulants, as they have an increased risk of intracranial bleeding. Notably, TBI symptoms in older adults may be mistaken for or mimic dementia.

    • Loss of functional independence.

    • Psychological impacts such as depression.

    • Increased rates of institutionalization.

    • Death.

  • Fear of Falling: This phenomenon can lead to a self-imposed reduction in physical activity, which subsequently worsens muscle weakness, decreases quality of life, and diminishes independence.

Nursing Assessment and Prevention of Falls

  • Nursing Prevention Strategies:

    • Comprehensive assessment of prior fall history.

    • Thorough medication review to identify high-risk drugs.

    • Management of orthostatic blood pressure.

    • Implementation of the Timed Up and Go (TUG) test to assess mobility and balance.

    • Modification of the home or hospital environment to remove hazards.

    • Education for both the patient and their family members.

    • Encouragement of regular mobility and physical activity.

    • Ensuring the patient utilizes corrected vision (glasses) and hearing (hearing aids).

    • Verification of the use of proper and well-maintained assistive devices.

  • Orthostatic Hypotension Assessment:

    • Definition: A drop in blood pressure characterized by a decrease of ≥20 mmHg\geq 20\,mmHg systolic or ≥10 mmHg\geq 10\,mmHg diastolic upon standing.

    • Measurement Procedure:

      1. Measure blood pressure after the patient has been lying down for 5 min5\,\text{min}.

      2. Measure blood pressure again after the patient has been standing for 1 min1\,\text{min}.

      3. Measure blood pressure a final time after the patient has been standing for 3 min3\,\text{min}.

Physical Activity and Aging

  • Benefits of Exercise: Physical activity improves muscle strength, cardiovascular endurance, flexibility, balance, cognitive function, and mood. It promotes independence and significantly reduces the overall risk of falls.

  • Exercise Components:

    • Training should encompass strength, endurance, flexibility, and balance.

    • Tai Chi is a highly recommended form of exercise for improving balance in older adults.

  • Modifications for Cognitive Impairment: When working with patients who have cognitive deficits, nurses should provide direct supervision, use simple and concise instructions, and focus on familiar, repetitive activities.

Sleep and Aging: Normal Changes and Hygiene

  • Normal Age-Related Sleep Changes:

    • Increased sleep latency (it takes longer to fall asleep).

    • Frequent nocturnal awakenings.

    • Reductions in structural sleep quality: Less time spent in Stage N3N3 and REM sleep.

    • Increased frequency of daytime napping.

    • Shifts in circadian rhythm (earlier bedtime and earlier wake time).

  • Stages of Sleep:

    • N1: Lightest sleep stage.

    • N2: Characterized by regular heart rate and breathing patterns.

    • N3: Deep, restorative sleep; essential for tissue repair and the release of growth hormone.

    • REM (Rapid Eye Movement): Phase characterized by vivid dreaming and high brain activity; the body typically experiences temporary muscle paralysis during this stage.

  • Sleep Hygiene and Interventions:

    • Recommendation of a consistent sleep/wake schedule.

    • Use of a sleep diary to track patterns.

    • Regular physical exercise.

    • Relaxation techniques prior to bed.

    • CBT-I (Cognitive Behavioral Therapy for Insomnia): Recognized as the first-line treatment for sleep disturbances.

Pathological Sleep Conditions

  • Insomnia:

    • Definition: Difficulty sleeping for a duration of ≥1 month\geq 1\,\text{month}.

    • Chronic Insomnia: Symptoms occurring > 3\,\text{nights/week} for a period of ≥3 months\geq 3\,\text{months}.

    • Risks: Associated with an increased risk of falls and cardiovascular mortality.

  • Obstructive Sleep Apnea (OSA):

    • Risk Factors: Advanced age, obesity, alcohol consumption, and depression.

    • Symptoms: Loud snoring, excessive daytime sleepiness, and morning headaches (HA).

    • Treatment (Tx): Diagnostic sleep study, CPAP (Continuous Positive Airway Pressure) therapy, and weight loss interventions.

  • Restless Legs Syndrome (RLS):

    • Symptoms: Sensations of crawling or tingling in the legs paired with an irresistible urge to move them; symptoms typically worsen at night.

    • Treatment (Tx): Iron supplementation if a deficiency is present, stretching, regular exercise, and the avoidance of caffeine, alcohol, and tobacco.

  • REM Sleep Behavior Disorder:

    • Etiology: A loss of the normal muscle paralysis experienced during REM sleep, leading patients to act out their dreams.

    • Clinical Significance: Often associated with the future development of Parkinson disease or Lewy body dementia.

Foot Care, Mobility, and Social Health

  • Foot Care and Mobility:

    • Foot deformities significantly impair gait and increase fall risk.

    • Diabetes and Peripheral Vascular Disease (PVD): These patients require specialized care. Only qualified healthcare providers should perform nail care. Yearly comprehensive foot exams are mandatory. Patients should be advised to avoid commercial nail salons.

  • Social Health and Engagement:

    • Social Isolation: Defined as an objective lack of social relationships. It increases the risk for heart disease, stroke, diabetes, depression, dementia, and premature death.

    • Social Engagement: Participation in social activities improves physical and mental health, enhances brain function, boosts quality of life, and supports healthy aging.

Spirituality and Psychosocial Development

  • Spirituality vs. Religion:

    • Spirituality: A broad concept involving the search for meaning, purpose, hope, and connection; it is not necessarily tied to a specific institution.

    • Religion: A structured system of specific beliefs, rituals, and organized practices.

  • Spiritual Distress:

    • Risk Factors: Facing a life-threatening illness, depression, cognitive impairment, loss of hope or faith, or the inability to participate in traditional religious rituals.

  • Nursing Interventions for Spiritual Health:

    • Therapeutic Communication: Inquire about what gives the patient meaning, what brings comfort, and their sources of strength. Practice active listening and maintain respect for all beliefs.

    • Clinical Actions: Provide privacy for prayer or reflection, involve family members as requested, offer the services of a chaplain, support the patient's specific rituals, and assist the patient in exploring the meaning of their life.

  • Gerotranscendence: A developmental shift in the elderly from a materialistic and rational view of the world to a more cosmic and transcendent perspective, which is associated with increased life satisfaction.

  • Wisdom: The reflective and pragmatic use of life experiences; it is a key driver for successful aging.

  • Self-Actualization: Reaching one's highest potential. It is characterized by traits such as courage, altruism, humor, moral development, and continuous self-renewal.