Chapter 19
Senior Health
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
Aging is a natural process that affects all living organisms.
Chronological age
The young-old (ages 65-74)
The middle-old (ages 75-84)
The old-old (ages 85 and older)
The elite-old (more than 100 years old)
Functional age
Functional ability and the ability to perform activities of daily living (ADLs)
A better measure of age than chronological age
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
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Why Do People Age?
Biological theories
Events that occur randomly and accumulate over time (stochastic theories)
Predetermined aging (nonstochastic theories)
Psychosocial theories: how one experiences late life (behavioristic)
Disengagement theory—withdrawal, decreased interaction
Activity theory—remaining active and involved is necessary to maintain life satisfaction
Continuity theory—continue through life as in previous years
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
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Demographic Characteristics
Americans are living longer than ever before and the older population will continue to grow.
Older population is becoming more diverse.
Number of seniors differs by geographic location.
Older women outnumber older men.
Older men are more likely than older women to be married.
Educational attainment has increased among older adults.
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
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Demographic Characteristics (Cont.)
Older women are more than twice as likely as older men to live alone.
Older adults want to live in their own home for as long as possible—“age in place.”
Alternative housing options are available with services to help seniors.
With aging, a good percentage of income is spent on health care.
The proportion of the older population living in poverty has decreased but is affected by gender, marital status, race, and ethnicity.
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
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Psychosocial Issues and Role Changes Affecting Seniors
Retirement
Relocation
Widowhood
Loss of family and friends
Possibly raising their grandchildren
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
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Physiological Changes of Aging
Occur in all body systems
Rate and degree of changes are highly individualized
Influenced by:
Genetic factors
Diet
Exercise
The environment
Health status
Stress
Lifestyle choices
And many other elements
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
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Wellness is different than “good health.” Wellness exists at one end of a continuum with illness at the other end. Health promotion programs focus on helping individuals to maintain their wellness, prevent illness, and manage any chronic illnesses that the individual may have. Preventive health services are valuable in improving the individual’s health status to maximum wellness potential.
– Nies & McEwen (2015)
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
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Recommended Health Practices
Encourage recommended health care screenings and examinations.
Encourage physical activity and fitness.
Evaluate the nutritional status and needs of older adults.
Monitor chronic illnesses.
Monitor medication use.
Monitor and accommodate sensory impairments.
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
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Recommended Screenings and Exams for Health Promotion and Disease Prevention
For All Older Adults
Complete physical: Annually
Blood pressure: Annually
More often if hypertensive or at risk
Blood glucose: Annually
More often if diabetic or at risk
Serum cholesterol: Every 5 years
More often if at risk
Fecal occult blood test: Annually
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
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For All Older Adults
Sigmoidoscopy: Every 3 to 5 years
OR
Colonoscopy: Every 10 years
More often if high risk
Visual acuity and glaucoma screening: Annually
Dental exam: Annually for those with teeth; cleaning every 6 months (every 2 years for denture wearers)
Hearing test: Every 2 to 5 years
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
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Recommended Screenings and Exams for Health Promotion and Disease Prevention (Cont.)
For All Older Women
Breast self-exam: Monthly
Clinical breast exam: Annually
Mammogram: Every 1 to 2 years if age 40 or older
Check with HCP if 74 years+
Pelvic exam and Pap smear: Annually
Check with HCP about discontinuation at 65 or older with three consecutive negatives exams and no abnormal in previous 10 years and not otherwise at risk
Digital rectal exam: Annually with pelvic exam
Bone density: Once after menopause
More often if at risk
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
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Recommended Screenings and Exams for Health Promotion and Disease Prevention (Cont.)
For All Older Men
Digital rectal exam and prostate exam: Annually
Prostate-specific antigen (PSA) blood test: Annually
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
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Recommended Screenings and Exams for Health Promotion and Disease Prevention (Cont.)
Immunizations for Older Adults http://www.cdc.gov/vaccines/schedules/downloads/adult/mmwr-adult-schedule.pdf.
Immunizations for All Older Adults
Tetanus, diphtheria, pertussis: Every 10 years
Influenza (flu) vaccine: Annually
Pneumonia vaccine: Once after age 65
Ask physician about booster every 5 years
Hepatitis A and B: For those at risk
Herpes zoster (shingles): One-time dose
Varicella: If evidence of lack of immunity and significant risk for exposure
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
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Encourage Physical Activity and Fitness
Physical activity …
Improves functional status
Reduces blood pressure and cholesterol
Decreases insulin resistance
Prevents obesity
Strengthens bones
Reduces falls
Walking is one of best forms of exercise.
Barriers: Pain, fatigue, lack of access to safe areas, impairment in sensory function and mobility
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
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Assess Nutritional Status
Poor nutrition in older adults is common.
Obesity in adults over 70 years and older has been increasing.
Normal physiological changes related to aging affect nutritional status.
Income, functional status, medications, social isolation, transportation, and dependence on others affect nutrition as well.
Recommend myplate.gov for assessment of eating patterns.
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
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Nutrition Checklist for Seniors: Warning Signs of Poor Nutritional Health
D isease
E ating poorly
T ooth loss/mouth pain
E conomic hardship
R educed social contact
M ultiple medications
I nvoluntary weight loss/gain
N eed assistance in self-care
E lder years (>80 years old)
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
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Monitor Chronic Illnesses
Chronic disease is the leading cause of death among persons 65 years and older.
The prevalence of chronic disease increases with aging; many older adults have at least two chronic conditions.
The most common conditions are arthritis, hypertension, and diabetes.
Chronic illness is a major cause of disability and may cause limitations with activities of daily living (ADLs and IADLs).
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
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Monitor Medication Use
Older adults consume more than one third of all Rx drugs, as well as many OTC drugs and “folk” remedies.
Age-related changes influence the effects of drugs.
Polypharmacy may lead to drug interactions and dangerous adverse reactions.
Most emergency hospitalizations for adverse drug events are caused by a few commonly used medications.
Closely monitor medication use in homes to ensure safety.
Older adults should be educated about potential adverse reactions, including drug-drug and drug-food interactions.
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
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Monitor and Accommodate Sensory Impairment
Visual impairment impacts social abilities, depression, falls, and communication.
Cataracts, macular degeneration, diabetic retinopathy, and glaucoma
Hearing loss one of most common conditions affecting older adults.
Presbycusis and tinnitus
Dental problems are neglected because of inadequate dental care, limited mobility and transportation, poor nutrition, myths, lack of finances and reimbursement.
Incontinence affects quality of life and is a symptom of underlying problems.
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
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Elder Safety and Security Needs
Falls
Traumatic brain injury (TBI)
Driver safety
Residential fire-related injuries
Cold and heat stress disorders
Elder abuse
Crime
Psychosocial disorders
Anxiety disorders
Depression
Substance abuse
Suicide
Alzheimer’s disease
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
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Alzheimer’s Disease
Slowly progressive brain disorder: begins with mild memory loss; progresses through stages to total incapacitation and eventually death.
Diagnosing is difficult; often reached after all other conditions ruled out.
Assessment tools include:
Mini-Cog, MIS, and GPCOG
Clock drawing
No cure and limited treatment options are available.
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
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Alzheimer’s Disease (Cont.)
Behavioral and physical changes create many challenges for caregivers.
Management strategies include:
Appropriate use of available treatment options
Management of coexisting conditions
Coordination of care among professionals and caregivers
Participation in activities and adult day care programs
Support groups and support services
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
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Spirituality
Involves “finding core meaning in life, responding to meaning, and being in relationship with God/Other” (Manning, 2013)
Spirituality has health benefits—resilience
Nurses should address spiritual needs and concerns as part of holistic care.
Interventions include nurses’ presence, active listening, caring touch, reminiscence, prayer, hope, nonjudgmental attitude, facilitation of religious practices, referral to spiritual care experts.
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
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End-of-Life Issues
Patient Self-Determination Act (PSDA)
Federal law enacted in 1990
Requires health care facilities that receive Medicare and Medicaid funds to ask patients on admission if they possess advance directives.
Living wills
Durable power of attorney
DNR (do-not-resuscitate) order
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
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Nurse’s Role in End-of-Life Issues
Discuss and educate patients about end-of-life issues.
Inform other members of the health care team about advance directives.
Make sure that the document is visible and accessible in the patient’s chart.
Encourage patients to discuss their wishes with their family.
Encourage patients to discuss with physician so it becomes part of medical record.
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