Health Alterations Health Alterations inin
Older Adults Older Adults
Janet Duffey, RN, MS, APRN, BC
Think About This…. A group of Florida senior citizens were talking about
their ailments.
"My arms are so weak I can hardly hold this cup of coffee."
"Yes, I know. My cataracts are so bad I can't even see my coffee."
"I can't turn my head because of the arthritis in my neck."
"My blood pressure pills make my dizzy.""I guess that's the price we pay for getting old."
"Well, it's not all bad. We should be thankful that we can still drive."
General Changes
Non regeneration Loss of neurons in cerebral cortex Decreased oxygen, blood flow Impaired thermoregulation Susceptibility in choline Dopamine Alteration in functional mobility
Neurological Diseases
Parkinson’s: pill rolling, tremors, forward gait, mask like expression, depression
Stroke (CVA): location, right brain, left brain, motor tracts
Hemorrhagic, occlusive, thrombotic
TIA’s – mini-thrombotic episodes resolving in 24 hours or less
CVA’s Effects of CVA’s
– language – Speech– Sensation– perception – behavioral style– memory and – holistic assessment
Expressive aphasia (Broca’s) frontal lobe damage
Receptive aphasia (Wernike’s) left hemi in temporal lobes
Impact of CVA
Overlooking Confusion Poorly understood event Multiple causes Misdiagnosis as “untreatable” Range of causes from age related
memory loss to pathological change in brain
Physical dysregulation: sleep, temperature, electrolytes, sensory overload
Nursing Interventions for Confusion
Baseline mental status exams Detect and report: insomnia, distractibility,
hypersensitivity, c/o poor recall, nightmares Structure environment for moderate mental and
physical stimulation Limit duration of activity Evaluate new / added meds carefully
Confusion
Causes of Acute Confusion
Metabolic Drug toxicity or side effects Drug withdrawal Electrolyte imbalance Endocrine dysfunction Hypoxia Infection and sepsis
Alzheimer’s Disease
Genetic predisposition Presence of amyloid plaques &
neurofibilary tangles (key finding on scans & autopsy)
Reduced presence of choline required for cognition (major biochemical change)
Dementia: Early Stage
Mood change Poor judgment Getting lost Difficulty with numbers
& money Withdrawal or depression
Middle Stage AD
Gross memory impairment Aphasia: speech disturbance Loss of impulse control Anxiety Wandering Confabulation Progressively lowered stress threshold Impaired self-care due to judgment
Late Stage AD
Dysphagia with risk for aspiration Impaired speech, little or no
communication Immobile, non-ambulatory Totally dependent in all activities of daily
living Morbidity by aspiration pneumonia or
sepsis common
Rx: Cholinesterase Inhibitors Cholenergic Drugs: Cognex,
Aricept Rivastigmine, improving concentration of acetylholine
Memantine: newly approved Side effects: nausea, bradycardia,
elevated liver function studies Used in early to middle stages
Behaviors in Dementia
Perseverance Tactile wandering Recreational Purposeful “Sundowning” Gross agitation Hallucinations Delusions
Interventions for Behaviors
Determine underlying need Check for pain, hunger, toileting issues Decrease stress if possible Encourage rest periods Engage in activities related to premorbid
personality and role PRN medications as a last resort, sparingly
Non-AD Dementias
Pick’s Disease Lewy Body Dementia Vascular Dementia
– Risk factors– MRI. CT findings– Prevention– Treatment of
symptoms similar to AD
Renal / Urinary System
Renal function Hydration Obstructive conditions Incontinence
– Stress– Urge– Overflow– Functional
Interventions
Moderate fluid intake Regular toileting Treatment of infection Estrogen therapy Timing of diuretics Medication assessment for contributors Bladder retraining
Changes in Skin Easily torn & blistered Decreased sensation leads to risk for injury Impaired thermoregulation Dryness Photo aging, cancers, basal cell epitheliomas,
squamous cell carcinomas, multiple melanoma Increased risk for fungal infections Implications for nursing care:
- Teaching to prevent sun exposure
- Avoid excessive bathing - Role of nutrition and hydration - Pressure relief measures - Assessment: Braden Pressure Scale
Pressure Ulcers in Elderly
Prevalence varies by setting Risk factors for elderly
– Acute immobility due to illness– Paralysis– Hip fracture– ICU/Critical care units– Nutritional state
Braden’s Conception of Risk
Decreased mobility Decreased activity Decreased sensory
perception Increased: moisture,
friction, shear Poor nutritional intake Advanced age Impaired circulation
Alterations in GI Function Decreased GI acidity Constipation Changes in appetite Role of dental problems Diverticulosis Colon cancer Self management of
colostomy
Interventions for Constipation Constipation vs.
obstruction Definition of “regularity” Establish fluid intake of
2000cc daily High fiber diet: bran,
fruits, vegetables, whole grains
Limit use of enemas and stimulants which cause more dehydration
Alterations in MS Status
Osteoarthritis Rheumatoid arthritis Osteoporosis Falls Fractures: vertebral, pelvis, hip, shoulder,
wrist Normal: decreased muscle mass, less
elastic, shrinking height
Interventions for MS
Diet, calcium, vitamin D HRT: estrogen Exercise Safety measures
– Hazards of immobility– Identification of appropriate activities– Fall prevention & home safety
Risk Factors for Falls
Sensory deficits Cardiac contributors Neurological Urological Pharmacological Alcohol Environment Fall history
Interventions for Falls
Identify fear of falling Increase activity Strengthening exercises Orthostatic monitoring Use of assistive devices Safe, non-skid footwear Correct sensory deficits
Plan how to get help after a fall
Remove known hazards: rugs, clutter
Identify activities requiring supervision / assistance
Teach caregivers proper lifting or transfer techniques