👵 Chapter 14 – Older Adults (>65)
🔄 Variability Among Older Adults
- Wide range of physiological, cognitive, and psychosocial health
- Different levels of functional ability
- Chronic conditions complicate care
- ❌ Do not assume all changes = disease; sometimes is just their body is getting older.
- ✅ Focus on strengths, independence, and abilities
🚫 Myths & Stereotypes
- Ageism = discrimination due to age (illegal)
- Nurses should:
- Promote positive perceptions of aging
- Value older adults’ experiences
- Use objective clinical judgment
👩⚕️ Nurses’ Attitudes
- Reflect on personal beliefs about aging
- Influenced by experiences, education, co-workers, and institutions
- Positive attitudes + specialized knowledge = better care
🧩 Developmental Tasks for Older Adults
- Face changes/losses in: health, loved ones, usefulness, socialization, income, independence
- Adjust to:
- 🛑 Retirement
- 🏠 Residence changes
- 💔 Death of spouse
- Support from adult children may vary
🏡 Community & Institutional Care
- Settings: private homes, apartments, retirement communities, day care centers, assisted-living, senior living
- Nurses + social workers = info & guidance on care options
🩺 Assessing Needs of Older Adults
🌍 Gerontological Nursing
- Care based on mutual goals (older adult, family, health team)
- Assess:
- Physical + psychosocial aspects of aging
- Disease/disability effects on function
- Tailor assessments individually
⚙️ Physiological Changes
- General survey: visible signs of aging
- 🧴 Integumentary: ↓ resilience, ↓ moisture
- 👤 Head & Neck: more pronounced features, ↓ vision/hearing, ↓ saliva & taste
- 🌬 Thorax/Lungs: ↓ muscle strength, ↑ AP diameter
- ❤️ Heart/Vessels: ↓ contractile strength → ↓ cardiac output
- 👩 Breasts: ducts replaced by fat → less firm, smaller, less nodular
- 🍽 GI: ↑ trunk fat (They lose fat in arms and legs but gain fat around the trunk/abdomen.)
- 🍽 GI: ↓ peristalsis (slower bowels), altered secretions
- ⚥ Reproductive: hormonal changes alter structure/function
- 🚻 Urinary: prostate hypertrophy (men), ↑ incontinence (women > men)
- 💪 Musculoskeletal: ↓ muscle fibers, ↓ bone density/mass
- 🧠 Neuro: slower reflexes, ↓ response to multiple stimuli
🧍 Functional Changes
- ADLs = physical, psychological, cognitive, social domains
- Decline usually linked to illness or chronicity
- Nursing goal: maintain, restore, maximize independence while ensuring safety & dignity
🧠 Cognitive Changes
- Delirium: acute, reversible confusion (Like when talking trash when fever)
- Dementia: progressive, irreversible cognitive decline (Can’t remember some stuff anymore)
- Depression: common, screen with Geriatric Depression Scale
💬 Psychosocial Changes
- Retirement
- Social isolation
- Sexuality concerns
- Housing/environment changes
- Death & grief
📊 Health Concerns (Healthy People 2030)
- 🧠 Dementia
- 🍔 Nutrition & foodborne illness
- 🦴 Osteoporosis
- 🫁 Respiratory disease
- 👂 Sensory/communication disorders
- 🦷 Oral health
- 🚑 Injury prevention
🏥 Physiological Concerns
- ❤️ Heart disease
- 🫁 Chronic lung disease
- 🎗 Cancer
- 🧠 Stroke
- 🚬 Smoking
- 🍺 Alcohol abuse
- 🍽 Nutrition, dental issues
- 🏃 Exercise
- 🤕 Falls
- 👓 Sensory impairments
- 💊 Pain & polypharmacy
💙 Psychosocial Concerns
- 🚨 Elder mistreatment
- 🗣 Therapeutic communication
- ✋ Use of touch
- 🧭 Reality orientation
- ✅ Validation therapy (non-confrontational approach to communication and care for individuals with cognitive impairments, such as dementia)
- 🕰 Reminiscence therapy (a psychotherapeutic approach that focuses on encouraging older adults to recall and reflect on significant life experiences)
- 🪞 Body image interventions
🏥 Older Adults in Acute Care
- ↑ Risks for:
- Delirium
- Dehydration
- Malnutrition
- HAIs (healthcare-associated infections)
- Incontinence
- Falls
🔄 Older Adults in Restorative Care
- Continuation of recovery post-illness
- Support for chronic conditions
- Goal: regain/improve prior independence (ADLs + IADLs)
- Focus on safe functioning in living environment