Mental Health Nursing: Aging Population and Geriatric Care Notes on Geriatric Care

Learning Outcomes for Mental Health Nursing: Aging Population

• Conceptual Discussion of Aging: Comprehensive exploration of what aging entails as a biological and social process.

• Social Trends: Analysis of historical and current demographic shifts within the aging population.

• Mental Challenges: Identification of five distinct mental health challenges frequently encountered by older adults.

• Nursing Actions: Categorization of specific nursing interventions and specialized care strategies for geriatric patients.

Foundations of Aging and Demographic Trends

• Definition and Process of Aging:     * Aging is defined as a continuous process that begins at the moment of birth.     * It is fundamentally characterized as the chronological and physiological process of getting older.

• Statistical Trends and Projections:     * The Pew Report: According to this report, by the year $2030$, every member of the Baby-Boomer generation will have reached at least $65$ years of age.     * Department of Health and Human Services Data: This agency reports a significant rise in the geriatric demographic, noting that the population of individuals aged $65+$ will increase from $35$ million in the year $2000$ to $55$ million by the year $2020$.

• Mental Health Status:     * Despite common stereotypes, most individuals aged $65$ and over remain intellectually intact and mentally healthy.

General Challenges Involved With Aging

• Prevalence of Physical and Sensory Issues:     * Certain chronic and acute illnesses become significantly more prevalent as individuals age.     * There is a notable diminution in sensory acuity, specifically regarding visual and hearing capabilities.     * Safety becomes a paramount issue due to these sensory and physiological declines.

• Multifaceted Losses:     * Financial and Professional: Loss of employment, resulting changes in income, and subsequent shifts in lifestyle.     * Social and Relational: Loss of an established social group, and the profound impact of the death of a spouse or family members.

• Ageism:     * Defined as discrimination strictly based on the age of an individual.     * It operates on the flawed assumption that most people over the age of $65$ are inherently incapable of functioning or making meaningful contributions to society.

• Intimacy and Sexuality:     * The fundamental human need for intimacy persists throughout the entire lifespan and never leaves the individual.     * Social Stigma: There is a persistent social stigma regarding older people participating in sexual activities or choosing to "live together."     * Intimacy Dichotomy: A conflict exists where the internal need for intimacy remains constant while the external social support group is simultaneously dying or becoming chronically ill.

• Elder Abuse:     * Can manifest as either physical or emotional abuse.     * Abuse is frequently perpetrated by family members or professional health-care providers.     * Regulatory Protection: The Omnibus Budget Reconciliation Act (OBRA) is a federal act that establishes mandatory standards of care specifically for the older population to mitigate neglect and abuse.

Clinical Illnesses and Cognitive Concerns

• Common Conditions:     * Alzheimer’s disease.     * Depression.     * Stroke (Cerebrovascular Accident or CVA).     * Aphasia (impairment of language).     * Insomnia.     * Paranoid thinking.

• Specific Focus: Alzheimer’s Disease:     * Characterized by a profound alteration in cognitive thinking.     * Possesses devastatingly debilitating effects on the patient.     * The condition is not reversible.     * Pathophysiologically identified by the presence of amyloid plaques and neurofibrillary tangles in the brain.

Medication Management and Pharmacokinetics

• Pharmacokinetic Changes: The physiological processing of drugs (absorption, distribution, metabolism, and excretion) is significantly slower in the elderly.

• Risk Factors:     * Compliance: Challenges in patients adhering to their prescribed medication regimens.     * Toxicity: Slower metabolism increases the risk of drugs reaching toxic levels in the bloodstream.     * Affordability and Availability: Practical concerns regarding whether the patient can afford or even access their medications.

• Common Medication Side Effects:     * Dry mouth.     * Constipation.     * Orthostatic hypotension (a drop in blood pressure upon standing).     * Urinary complications.     * Confusion and disorientation.     * Fatigue.     * Mood swings.

Restorative Nursing and Palliative Care

• Restorative Nursing:     * A branch of rehabilitation focused on maintaining patient dignity and achieving the maximum possible level of function.     * Primary Goals: Promoting independence, enhancing self-esteem, and enabling the patient to maintain control over their life and activities of daily living (ADLs).     * Staffing Requirements: Most skilled nursing facilities must provide at least one designated nursing assistant and one nurse who have received specialized training to be part of the "restorative" team.     * Regulatory Oversight: Restorative programs are essential for facility documentation, reimbursement requirements, and are graded during state and federal surveys.

• Palliative Care:     * Specialized medical care for individuals with serious illnesses, focusing on the management of uncomfortable symptoms and the stress associated with advanced illness.     * Often encompasses end-of-life care with a focus on quality of life for both the patient and their family.     * Clinical Issues in Palliative Care: Pain management, sedation, opioid medication administration, artificial nutrition and hydration, and addressing issues of assisted suicide.     * Nurse Responsibilities: Nurses must hone communication skills and remain cognizant of religious, cultural, ethical, and legal issues, particularly concerning heavy sedation and end-of-life choices.

Medical and Alternative Treatments

• Medical Care: Treatment is strictly related to specific symptoms and official diagnoses. It requires careful monitoring of dosages and patient compliance.

• Therapeutic Modalities: Individual or group therapy may be indicated, alongside socialization activities to combat isolation.

• Alternative Care Options:     * Nutritional supplements.     * Massage therapy.     * Aromatherapy.     * Neurolinguistic programming (NLP).

Essential Nursing Interventions

• Show consistent respect to the patient.

• Collaborate with the patient to set achievable goals.

• Display deliberate patience and understanding.

• Utilize and maintain appropriate humor to build rapport.

• Ensure environmental and physical safety.

• Promote independence to the highest degree possible.

• Apply communication techniques appropriate for the patient's cognitive and sensory status.

Reflection and Review Questions

• Question 1: Which agency claims the following: ‘The population of $65+$ will increase from $35$ million in $2000$ to $55$ million in $$2020$’?     * Answer: C. Department of Health and Human Services.

• Question 2: Identify the challenge(s) of aging: A. Spouse and family, B. Employment, C. Lifestyle, D. Social group.     * Answer: E. All of the above.

• Question 3: The following are challenges to aging except:     * Answer: D. Too much intimacy. (Alzheimer's, medication concerns, elder abuse, and age discrimination are all confirmed challenges).

• Question 4: Common medication side effects except for:     * Answer: A. Salivating. (Confusion, constipation, and orthostatic hypotension are confirmed side effects; dry mouth is more common than salivating).