Geriatric Nursing Terms

geriatrics- study of old age including physiology, pathology, dx., & treatment of diseases of old adults gerontology- broader, the study of the aging process including biological, psychological, & sociological gerontologic or gerontic nursing- specializes in care of the elderly 3.

1. 2. 3.

67% live in family setting 66%- child within 30 minutes 62%- weekly visits

4. 76%- talk weekly sickness & aging synonymous 1. 2. almost 50% rate health as good or excellent 28% 65+ assessed poor health

4. 5.

incapable of learning- although slowed due to reflexes, capable of learning new things no longer interested in sexuality/ sexual act 1. sexuality (lifelong need) 2. can provide intimacy & love without sexual relations

Aging
normal process of time related change starting with birth & continuing throughout life way person ages influenced by 1. 2. 3. 4. 5. genetics lifestyle availability & quality of health care socioeconomics

6.

constipation/ incontinence- expected 1. never normal 2. 3. constipation due to inactivity or diet incontinence- seek medical help

7.

old age- final phase of life predict by 2030- 69.4 Million (8 Mil. over 85) 23% over 65 while only 18% under 18 ageism- prejudice against distinct group define by age boundariesstereotypes 1. 1. 2. 3. simplified and often untrue beliefs reinforce society's negative image of the aged about 5% live in nursing homes 9. 8.

senility- expected result of age 1. senility (dementia found in elderly) 2. dementia- result of disease- not aging elderly financially impoverished 1. 2. median net worth- $86,300 poverty rate- 12.9%

3. median income- $28,983 spend last years in nursing home 1. 2. about 5% in nursing home % increases with age (+1%- 65-74, +4%- 7584, 20%- 85+)

Old Age
definition varies with frame of reference society indicates age 65 as beginning of old age 1. 1. 2. 3. young-old- 65-74 middle-old- 75-84 old-old- 85 & up

Income
Social Security (Federal Old-Age, Survivors, & Disability Insurance) 1. 1. 2. 3. single largest source funded by employee & employer payroll taxes benefits determined by age, earnings, & credits worked

Terms
life span- maximum number of years person can live under the best of conditions in absence of disease life expectancy- average number of years a person can be expected to live 2007: 77.7 years over 80% have @ least 1 chronic illness, 50% have 2 34 Million older- 4.4 Million (14.5%) difficulty with @ least 1 ADL (eating, bathing, dressing, transferring, toileting) about 1 of 8 fastest growing age group- over 75 2. 1. 2.

4. reduced benefits can start at 62 SSI- Supplemental Security Income provides for disabled, blind, or aged with limited incomes or resources generally under age 62

Psychological Aspects
developmental theories 1. 1. 2. 3. Freud, Sullivan Maslow (hierarchy of needs) Erikson 1. eighth stage- 65-100 years 2. integrity vs despair

Myths vs Reality
1. 1. 2. families do not care for elder- 80% do take care elderly- alone & deserted

1. 2. 4.

integrity- acceptance of self, in control, dignity despair- disappointed, dissatisfied, out

5. 6. 7. 8. 9.

skin drier & more susceptible to irritation change in pigmentation (age or liver spots) nails- thick & brittle less efficient cooling system less tolerance to temperatures

of control Peck (expanded Erikson), Havighurst

achievements & adaptations recommended for the aged 1. 1. 2. 3. 4. 5. 6. maintain feelings of worth resolve old conflicts; adjust to loss of power roles adjust to deaths of significant others adapt to environmental changes; maintain optimum level of wellness

10. Recommend 1. avoid sun 2. 3. 4. 5. avoid heat dress warmly in winter bathe 1-2 weekly oil or lotion prn

2. Nervous
1. 2. 3. 4. 5. slowed reactions altered sleep cycle short term memory loss impaired senses Recommend 1. 2. 3. at risk for accidents assist ADL prn watch for possibility of burns prn

Sociologic Theories
1. disengagement 1. controversial 2. 3. 4. 2. mutual withdrawal from social interaction by aged & society leisure is form of activity respects individual rights & values

3. Sensory
1. vision 1. 2. 3. 4. 5. presbyopia reading glasses problem with blue vs green difficulty adjusting to dark-light changes (night blindness) Recommend 1. 2. 3. 4. 5. 2. hearing 1. 2. 3. 4. presbycusis problem with some consonants cerumen accumulation Recommend 1. 2. 3. 4. 5. 6. 3. low tone speaking voice reduce background noise face person enunciate clearly moderate pace gestures prn adequate lighting avoid glare vision aids large print contrasting colors

activity 1. individual 2. 3. remains active & interacts with society pursues new friends & interests

3.

continuity or development 1. lifelong personality characteristics continue 2. supportive network of relationships established

Health Promotion & Maintenance

1. personal hygiene 1. bath 2-3/ week 2. 3. 4. 5. 6. 2. lotion prn shampoo 1-2/ week keep nails short dental supervision try to make dresssing easier (loose clothing, zippers, velcro)

exercise 1. individual planned 2. consider- general health, ?chronic illness, personal preference, environment, finances

3.

nutrition 1. balanced 2. decrease CHO, caffeine, fat, & Na

touch 1. sense of touch dulled 2. pain threshold higher taste 1. 2. dull salt & sweet (want more sweets) prefer salty & highly seasoned foods

Normal Aging Changes

1. Integumentary
1. 2. 3. 4. skin thinner less subcutaneous tissue wrinkles gray hair 4.

5.

smell- diminishes

4. Respiratory

1. 2. 3. 4.

decreased gas exchange & cough efficiency decreased activity tolerance more vulnerable to infection Recommend 1. exercise 2. 3. 4. 5. 6. no smoking not in smoking areas force fluids flu vaccine avoid exposure to infection

4. 5.

decreased saliva constipation 1. lack of bulk 2. 3. 4. 5. 6. 7. 8. 9. prolonged use of laxatives ignore urge to defecate drug side effects emotional problems inactivity insufficient fluid excess dietary fat Recommend 1. 2. 3. 4. 5. 6. regular dental & oral care small frequent meals sit up after meals no heavy activity after meals antacids with supervision limit laxatives

5. Reproductive
1. 2. 3. 4. 5. 6. decreased hormone production menopause in female decreased vaginal secretions penis & testes decrease in size sperm production slowed Recommend 1. 2. 3. sexual desires & activity decline but not disappear water-soluble lubricant sexual counselor prn

9. Urinary
1. 2. 3. 4. decreased nephron activity lose of muscle tone results in more frequent voiding retention, frequency, urgency, & incontinence common Recommend 1. 2. 3. 4. ready access to toilet, void regularly pelvic floor exercises avoid bladder irritants (caffeine, ETOH, sweetners)

6. Musculoskeletal
1. 2. 3. 4. 5. 6. osteoporosis pathologic fractures muscles lose strength, flexibility, & endurance height loss changes in posture Recommend 1. 2. 3. 4. 5. 6. high Ca, low Ph exercise handle gently reduce environmental hazards extra time to perform activities prevent deformities

10. Endocrine
o o
0. 1. 2. change in hormones decreased basal metabolic rate (BMR)

11. Immune
decreased function more susceptible to infection & disease atypical S&S of infection

7. Cardiovascular
1. 2. 3. 4. 5. 6. 7. heart disease leading cause of death heart valves-thicker & stiffer arteries lose elasticity & accumulate deposits decreased response to stress B/P increases cardiac output decreases Recommend 1. 2. 3. 4. 5. 6. exercise no smoking weight control low fat diet relieve stress check B/P

Mental Health Disorders

1. depression 1. most common affective, mood, or functional disorder 2. 3. 4. 5. can be reaction to loss of independence, status or spouse some medications physical illness & changes nursing 1. encourage self expression & esteem 2. 3. 4. 5. 6. 7. improve appearance provide structure & routine assist to maintain or regain control kind & understanding attitude safety, security realize potential for suicide 1. about 25% occur in over 65

8. GI
1. 2. 3. decreased motility decreased teeth ill fitting dentures

2. 2.

white males over 75 highest rate

4.

many not receiving full benefits due to lack of knowledge or inability to find out resources 1. lack of mobility

aggressive behavior 1. abnormal anger, rage, or hostility 2. 3. result of anxiety, stress, guilt, insecurity, forced dependence nursing 1. express feelings 4. 5. health 1. 2. 5.

2. health problems penalties of losing social security benefits if employed 40% more than one chronic disease increase in health care needs & costs

3. 4.

2. set limits other- regression, paranoid behavior rehabilitation for mental problems 1. reality orientation 2. 3. 4. 5. remotivation reminiscence cognitive training relaxation therapy

housing 1. prefer to remain independent 2. 3. 4. live with spouse, alone, or with family own own home alternatives (mobile homes, retirement communities, foster homes, life care facilities, nursing homes, homes for the aged, convalescent homes, rest homes, house sharing, public housing, rooming houses, 5. hotels for single room occupancy) require special assistance (transportation, meals, health hotlines, house cleaners, homemaker services, social services, home care services)

Role Changes
1. crisis- sudden, not able to plan for appropriate replacement, substitute not readily available, stress producing gradual- develop slowly & allow time for preparation changes generally crisis-forced retirement, loss of spouse, illness, friends move away or die, family relocate or assume new roles decreasing time for relationship role losses- work (no longer bread winner), family (no longer decision maker, loss of esteem or independence) role gains- new friends, activities, or interests, purpose & opportunity, rest & relaxation 6.

2. 3.

recreation 1. more time available 2. problems (cost, health, decreased energy, lack of incentive, sensory losses, lack of environmental aids, lack of conveniently located facilities) most depend on family alternatives (religious, community activities, day care, senior citizen centers, adult education, cultural events)

4. 5.

3. 4.

Alterations in Life-style
1. employment 1. increase in number of older females working 2. 3. 4. 5. decrease in number older males working parttime employment more common early retirement involuntary limitations (health, sensory or perceptual alterations, decline in strength, endurance, & speed) 6. 2. strengths (reliability, dependability, knowledge, expertise, experience)

Intelligence
test scores decline but due to slowed responses not actual ability learning capacity continues memory 1. 1. 2. short term concentration & retention decline remote generally better personality basically unchanged

Drugs & Elderly

account for 34% of Rx. & 40% of OTC average more than 11 per year decreased dosage due to decreased absorption, distribution, metabolism, & excretion Recommend 1. 1. 2. 3. 4. education administration times compatible with lifestyle color coding larger print

retirement 1. mandatory age raised to 70 2. 3. 4. 5. health problems major cause of voluntary retirement increased leisure time stressful when decreased ability to handle stress tremendous anxiety

3.

6. loss of daily routine & income economic 1. 2. 3. fixed incomes frequently below nation's poverty levels (1 of 10) costs increase buying power decrease

5. easily removable caps ETOH abuse- tolerance decreases with age, men more

4.

no slip wax on floors, no scatter rugs or deep pile avoid clutter rubber tips on canes tong reachers rather than stools or ladders temperature controlled faucets

Community
95% live in community 31% live alone married (40% female, 74% male) 48% females widowed but only 15% males (more remarry) 81% have living children

5. 6. 7. 8.

9. electric rather than gas, front controls 10. avoid trash accumulation 11. nonskid strips in tub or shower 12. handrails, high toilet seats, shower chairs 13. night light 14. siderails on bed prn 15. telephone by bed 16. proper lighting 17. stair rails, colored strips on step edges 18. no frayed wires 19. readily available emergency numbers 20. smoke detectors 21. crime prevention assessment 22. drug precautions

Elder Abuse
active or passive act or behavior that is harmful to the elderly physical violence (battering, sexual) personal neglect mental anguish (threat of institutionalization, social isolation, sensory deprivation) financial exploitation violation of rights (confinement or restraint) denial of health care self-inflicted abuse profile of abuser 1. 1. 2. 3. 4. 5. 6. 7. 8. 40-60 female son/ daughter, relative, caretaker married semi-skilled to professional whites 88% protestant high school to college

Personal Space
many are set in ways prefer to be in familiar place with memories should allow as long as possible

Medicare
federal social insurance program designed to provide health care to elderly entitled to social security benefits part A- hospital part B- medical 1. 1. 2. 3. (voluntary must pay additional fee out-patient

Prevention
1. 1. 2. 3. identify predisposing factors increase public awareness & education knowledge of community resources

elder must agree to be investigated

Safety
1. accidents

4. office visits not covered-nonskilled home nursing care, ongoing nursing home care, prescriptions, glasses, dental care deductible only pays 45% of health care costs

o o o o

leading cause of death falls most also fires & MVA more likely

Medicaid
health assistance from state & federal funds for the poor cover expenses not covered by medicare reduce expenses after medicare exhausted defray expenses for those unable to afford medicare fees

o o o o o o o
2. prevention 1. 2. 3.

decreased sense increased reflex time muscle weakness confusion, forgetful improper footwear environmental hazards drugs

Agency on Aging
created through Older Americans Act of 1965 state, regional, area, or local units services- nutrition (on site meals, home delivered meals), senior centers, home care (homemaker, home health aide, home visits, telephone calls, chore maintenance, repairs)

short or 3/4 sleeve no long garments chairs with arms

information & referral transportation

allow family time with deceased

Legalities
now must have information on advanced directives concerning durable power of attorney & living will durable power/ healthcare proxy-individual has power even if elder becomes disabled or incapacitated living will 1. 1. 2. 3. 4. 5. 6. document to prevent "heroic measures" to extend life written earlier most states accept copies should be available for all concerned individuals should talk with family do not put in safety deposit box

Dying Grief
natural & normal process experienced with loss Kubler-Ross- 5 stages (denial, anger, bargaining, depression, acceptance)

Nursing
1. 2. 3. pain mgt.- routine meds with prn for breakthrough pain physical- mouth care, eye drops, turn at least q2h, skin care, bowel & bladder care, grooming be aware of cultural aspects

Death
Impending Signs
Cheyne-Stokes (apnea alternating with dyspnea) extremities- cold, pale, & mottled skin moist & cool B/P & temp decrease, pulse increases pupils nonreactive verbal- weak or absent

hearing- last sense to go

rigor mortis- temporary stiffening for 24 hours

Post- mortem Care

Rx. with respect & dignity bathe remove dressing & tubes if no autopsy body alignment dentures replaced comb hair