Chapter 12 Health Care of the Older Adult

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Number of Persons Age 65+ 1900-2030

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Leading Causes of Death in Older Adults

Heart diseases Malignant neoplasms Cerebrovascular diseases Chronic obstructive pulmonary diseases, allied conditions Alzheimers disease Diabetes mellitus

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Leading Causes of Death in Older Adults (contd)

Pneumonia, influenza Nephritis, nephrotic syndrome, nephrosis Accidents (unintentional injuries) Septicemia

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Preventive Health Care

Encouragement Community-based support services Promote lifelong health behaviors

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Cardiovascular Changes
Decreased cardiac output Diminished ability to respond to stress Heart rate, stroke volume do not increase with maximum demand Slower heart recovery rate Increased blood pressure

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Respiratory System
Increase in residual lung volume Decrease in muscle strength, endurance, vital capacity Decreased gas exchange, diffusing capacity Decreased cough efficiency

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Integumentary System
Decreased subcutaneous fat, interstitial fluid, muscle tone, glandular activity, sensory receptors resulting in decreased protection against trauma, sun exposure, temperature extremes

Diminished secretion of natural oils, perspiration

Capillary fragility

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Reproductive System
Female: Vaginal narrowing, decreased elasticity; decreased vaginal secretions Male: Less firm testes, decreased sperm production

Male and female: slower sexual response

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Musculoskeletal System
Loss of bone density Loss of muscle strength, size Degenerated joint cartilage

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Genitourinary System
Male: Benign prostatic hyperplasia Female: Relaxed perineal muscles, detrusor instability (urge incontinence), urethral dysfunction (stress urinary incontinence)

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Gastrointestinal System
Decreased sense of thirst, smell, taste Decreased salivation Difficulty swallowing food Delayed esophageal, gastric emptying Reduced gastrointestinal motility

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Nervous System
Reduced speed in nerve conduction Increased confusion with physical illness, loss of environmental cues

Reduced cerebral circulation (becomes faint, loses balance)

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Special Senses
Vision: diminished ability to focus on close objects; inability to tolerate glare; difficulty adjusting to changes of light intensity; decreased ability to distinguish colors Hearing: decreased ability to hear high-frequency sounds; tympanic membrane thinning, loss of resiliency Taste and smell: decreased ability to taste, smell

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Question
Tell whether the following statement is true or false: The leading cause of injury and preventable source of mortality and morbidity in older adults is falls.

Copyright 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins

Answer
True. Rationale: The leading cause of injury and preventable source of mortality and morbidity in older adults is falls.

Copyright 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins

Hearing and Vision Changes

Presbycusis: decreased ability to hear high-pitched tones that naturally begins in midlife as result of irreversible inner ear changes Presbyopia: decrease in visual accommodation that occurs with advancing age

Copyright 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins

Question
What is an age-related change in the body system of the older adult? A. Decreased blood pressure

B. Decreased cardiac output

C. Increase bone density D. Increased salivation

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Answer
B. Decreased cardiac output Rationale: Age-related changes in body systems include increased blood pressure, loss of bone density, and decreased salivation.

Copyright 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins

Mental Health Problems in the Older Adult

Depression: most common affective disorder of old age; results from changes in reuptake of neurochemical serotonin in response to chronic illness, emotional stresses related to physical, social changes associated with aging process Delirium: acute, confused state that begins with disorientation If not immediately evaluated and treated, can progress to changes in level of consciousness, irreversible brain damage, sometimes death

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Dementia
Broad term for syndrome characterized by general decline in higher brain functioning (reasoning) with pattern of eventual decline in ability to perform even basic activities of daily living (toileting, eating)

Alzheimers disease
Vascular Dementia

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Question
Tell whether the following statement is true or false: The most common affective or mood disorder of old age is Alzheimers disease.

Copyright 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins

Answer
False. Rationale: The most common affective or mood disorder of old age is depression.

Copyright 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins

Nursing Care of the Older Adult

Geriatrics: field of practice that focuses on physiology, pathology, diagnosis, management of disorders, diseases of older adults Gerontological/geriatric nursing: field of nursing that relates to assessment, nursing diagnosis, planning, implementation, evaluation of older adults in all environments, including acute, intermediate, skilled care as well as within community

Gerontology: combined biologic, psychological, sociologic study of older adults within their environment

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Nursing Management
Supporting cognitive function Promoting physical safety Promoting independence in self-care activities Reducing anxiety, agitation Improving communication

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Nursing Management (contd)

Providing for socialization, intimacy needs Promoting adequate nutrition Promoting balanced activity, rest Supporting home-, community-based care

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Pharmacologic Aspects
Polypharmacy: administration of multiple medications at same time; common in older persons with several chronic illnesses Aging changes alter drug: Absorption Metabolism Distribution Excretion

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Nursing Implications
Need adjustment of dosage due to age; start low, go slow Assess medication knowledge, use

Need for medication review, coordination of prescriber

Problem of noncompliance: Factors that affect compliance

Keep medication regimen as simple as possible

Strategies to improve compliance
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Geriatric Syndromes
Impaired mobility Dizziness Falls, falling Urinary incontinence Susceptibility to infection Altered pain, febrile responses Altered emotional impact Altered systemic response
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Potential Economic Effects

Social services Health care costs of aging Home health care Hospice services Aging with a disability

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