Assessing the Older Adult

Acknowledgement of Traditional Owners

QUT acknowledges the Turrbal and Yuggera people as the First Nations owners of the lands where QUT stands.
Respect is paid to their elders, laws, customs, and creation spirits.
These lands have always been places of teaching, research, and learning.

Overview of the Week's Topics

Demographic data related to older adults in Australia.
Physiological changes associated with normal ageing.
Aged care standards.
Different assessment tools for older adults.
- Assessment of individuals with dementia.
- Assessment of individuals with disabilities.

Demographics of Older Adults

The number of older adults is rapidly increasing in Australia and worldwide.
Nurses are at the forefront of caring for older people across healthcare.
In 2016-2017, older adults (65+ years) accounted for:
- 1.6 million presentations to the emergency department.
- 1.8 million (41%) overnight hospitalizations.

Aged Care Services in Australia

Over 1.2 million people receive aged care services in Australia.
Services range from support for independent living at home to full-time care in residential facilities.
Many older people develop frailty, characterized by:
- Decreased physiological reserves.
- Weakened response to stressors.
- Increased risk of poor outcomes.

Expectations and Quality of Life

Older people today are generally more educated and well-traveled than previous generations.
They expect a higher quality of life.
Many will achieve healthy aging, while others manage chronic conditions.
Increasing dependence on caregivers is common.

Holistic Approach to Healthcare

Healthcare for older people is complex and requires a holistic approach.
Inclusion and support of family are essential.

Visualizing Changes in the Proportion of Older People

1901: 4% of the population aged 65+.
2011: 14% of the population aged 65+.
2101: 25% (projected).

Defining "Old" and Pension Entitlement

Defining an "old person" as 65+ is historically tied to pension entitlement.

Australian Institute of Health and Welfare Data (2019)

More females than males in the 85+ age group.
Significant increase in the number of older people.
The 85+ age group is the most rapidly increasing.

Classifications of Older Adults

Young old: 65-75 years old.
Old: 75-85 years old.
Old old: 85+ years old.

Global Population Trends

Global population is growing older.
Falling fertility rates and increasing life expectancies.
People over 65 are the fastest-growing demographic.

International Comparison

Australia compares well to other Western countries like New Zealand and Canada.
Japan has a very significant proportion of older people.

Physiological Changes with Ageing

Structural and physiological changes are part of the normal aging process.
Some changes can indicate underlying disease, so generalization should be avoided.

Holistic Care for Older People

The care of the older person requires a holistic approach, considering:
- Physical well-being.
- Psychological well-being.
- Spiritual well-being.
- Social well-being.
Nurses must know the person and their life history.
Older people should not be ignored or seen as a nuisance.

Dignity and Respect

Terminology used when addressing older people should be carefully considered.
Ensure the older person is seen and heard, and treated with dignity and respect within a person-centered model of care.

Physiological Reserves

Changes to physiological reserves occur with aging, independent of disease.
However optimal aging occurs in people who are free from disease.

Body Systems Approach

Neurological system (cognitive changes).
Cardiovascular system.
Respiratory system.
Genito-urinary and renal systems.
Gastrointestinal system.
Reproductive systems.
Musculoskeletal system.
Integumentary system.

Promoting Healthy Ageing

Maintain optimal nutrition.
Daily exercise.
Day-to-day function.

Neurological System Changes

Decreased rate of voluntary or automatic reflexes.
Decreased ability to respond to multiple stimuli.
Insomnia (shorter sleeping periods).
Neurons degenerate impacting responses and thinking.
The aging brain decreases in volume and number of cortical brain cells.
Changes to biochemistry and microanatomy.
Older people may complain about memory issues.
They may have trouble recalling names and details.
Information retrieval and processing is slower.
Learning new things takes longer.

Normal Brain vs. Aged Brain

The speaker showed a picture of a "normal hydrated brain" when referring to people in the course versus an "aged brain".

Dementia vs. Normal Aging

Dementia is not part of the normal aging process; it is a disease process.
Brain shrinkage is more significant in dementia patients.
Behavioural changes include a decline in mental flexibility and abstract thinking.

Cardiovascular System Changes

Significant increase in systolic pressure.
Slight increase in diastolic pressure.
Weaker pedal pulses.
Colder lower extremities.
Cardiac muscle decreases in size.
Decreased cardiac output.
Calcifications and fibrosis of cardiac valves.
Arterial system becomes increasingly rigid.
Aorta and large vessels can become atherosclerotic.
Pacemaker cells in the sinoatrial nodes decline, resulting in possible irregular heart rate.
Aortic murmur is common due to aging of aortic cusps and fibrous tissue buildup.
Calcification can result in aortic stenosis.

Respiratory System Changes

Increased anteroposterior diameter.
Increased chest rigidity.
Musculoskeletal changes leading to limited chest wall expansion.
Diaphragm flattens, decreasing respiratory endurance.
Decreased lung expansion.
Increased airway resistance.
Loss of alveolar capillaries and lung tissue.
Pulmonary wall thickening.
Cough reflex decreases, increasing the risk of aspiration.
Capacity for exercise decreases.
The dorsal curve of the thoracic spine may become more pronounced, resulting in kyphosis.

Genitourinary and Renal System Changes

Kidney shrinkage. Decrease in cortical volume. decrease in cortical medullary ratio and increase in surface roughness and increase in the number and size of renal cysts.
Glomerular filtration rate decreases.
Decreased renal filtration and renal efficiency.
Subsequent loss of protein from the kidney.
Bladder becomes less elastic due to reduced muscle tone.
Nocturia (frequent nighttime urination).
Decreased bladder capacity and urgency/frequency.
Increased risk of urinary tract infections.

Gastrointestinal System Changes

Decreased salivary secretions.
Swallowing difficulties.
Decreased number of taste buds.
Decreased peristalsis and decline in large bowel transit time.
Decreased production of digestive enzymes.
Reduced esophageal and gastric motility.
Musculature diminishes in mass and loss of tone.
Increased fat deposition in the abdominal area.
Loss of muscle elasticity in the anus and rectum.

Female Reproductive System Changes

Overall shrinkage of organs.
Decreased vascularity of the ovary, uterus, cervix, and vagina.
Vaginal dryness due to decreased estrogen levels.
Weakening of the pelvic floor.
Increased risk of incontinence or prolapses.
Loss of hormones increases the risk of osteoporosis.
Shrinking of ovaries due to decreased estrogen and progesterone levels.
Atrophy of the pelvic muscles, resulting in increased risk of incontinence.

Male Reproductive System Changes

Testicular degeneration resulting in decreased testicular size.
Testicles drop lower and become smaller.
Testosterone levels decline.
Decreased sperm count.
Enlargement of the prostate.
Increased risk of benign prostate hyperplasia or cancer of the prostate.
Increased risk of erectile dysfunction.

Muscular System Changes

Decreased joint mobility and decreased range of movement.
Enhanced bony prominences.
Increased risk of pressure injuries.
Decreased balance, strength, and endurance.
Increased risk of falls and injuries related to falls.
Increased risk of fractures, such as neck and femur fractures.
Skeletal muscles decrease in bulk and power.
Loss of height.

Integumentary System Changes (Skin)

Skin wrinkles and sags due to loss of turgor and elasticity.
Loss of vascularity, giving a paler appearance.
Skin may become dry, flaky, and rough.
Skin on the back of the hands becomes fragile, loose, and transparent.
Nails lose luster and may appear yellow and thicken.
Hair loses pigmentation and becomes gray.
Decreased number of scalp hairs.
Changes to temperature regulation can result in susceptibility to hypothermia.

Skin Assessment Considerations

Spotty pigmentation in areas exposed to the sun.
Dry and scaly skin.
Cooler extremities.
Decreased perspiration.
Decreased elasticity.
Wrinkles.
Decreased fat on extremities and increased fat on the abdomen.
Loss of subcutaneous fat over bony prominences.
Thinning of the epidermis.
Decreased vascularity of the skin.
Decreased sweat and sebaceous glands affecting thermoregulation.
Increased risk of skin tears, and increased risk of pressure injuries that are all preventable.

Hair and Nail Changes

Thinning and graying hair on the scalp.
Decreased amount of hair in axilla, extremities, and pubic area.
Decreased facial hair in men.
Increased chin and upper lip hair in women.
Loss of eyebrow hair in women.
More bushy eyebrows in men.
Decreased growth rate of nails.
Nails may thicken and split.
Toenails can become quite fibrous.

Importance of Understanding Normal Physiological Ageing

It is crucial for students in clinical placement to understand normal physiological ageing.

Physical Assessment Considerations

All physiological changes to the body systems need to be considered when undertaking a physical assessment and when considering normal health parameters.

Other Physiological Changes

The nodular thyroid gland can be normal, but in aging, the person might be aware that it's a little bit bulkier.
Eyes may appear recessed due to periorbital tissue atrophy.
Eyelids may develop ptosis from relaxation of the skin and weakening of the muscles.
Lower lids can develop ectropion.
The sclera becomes yellowish in color.
A white ring may develop around the iris.
Pupils may become smaller and slightly irregular.
Near vision begins to blur as the lens loses elasticity and the eyes become less able to accommodate.
Hearing generally diminishes with age, beginning with the loss of high-pitched sounds, followed by the lower and middle ranges.
Hearing aids may be required to ensure appropriate communication during the assessment process.

Sensory Considerations During Assessment

It is important to ensure that older people can engage with the assessment process by considering their sensory needs (vision and hearing).