Health Alterations in Older Adults

1. Health Alterations in Older Adults Janet Duffey, RN, MS, APRN, BC

2. 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."

3. General Changes • Non regeneration • Loss of neurons in cerebral cortex • Decreased oxygen, blood flow • Impaired thermoregulation • Susceptibility in choline • Dopamine • Alteration in functional mobility

4. 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

5. 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

6. Impact of CVA

7. 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

8. 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

9. Confusion

10. Causes of Acute Confusion • Metabolic • Drug toxicity or side effects • Drug withdrawal • Electrolyte imbalance • Endocrine dysfunction • Hypoxia • Infection and sepsis

11. 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)

12. Dementia: Early Stage • Mood change • Poor judgment • Getting lost • Difficulty with numbers & money • Withdrawal or depression

13. 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

14. 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

15. 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

16. Perseverance Tactile wandering Recreational Purposeful “Sundowning” Gross agitation Hallucinations Delusions Behaviors in Dementia

17. 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

18. Non-AD Dementias • Pick’s Disease • Lewy Body Dementia • Vascular Dementia • Risk factors • MRI. CT findings • Prevention • Treatment of symptoms similar to AD

19. Renal / Urinary System • Renal function • Hydration • Obstructive conditions • Incontinence • Stress • Urge • Overflow • Functional

20. Interventions • Moderate fluid intake • Regular toileting • Treatment of infection • Estrogen therapy • Timing of diuretics • Medication assessment for contributors • Bladder retraining

21. 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

22. 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

23. Braden’s Conception of Risk • Decreased mobility • Decreased activity • Decreased sensory perception • Increased: moisture, friction, shear • Poor nutritional intake • Advanced age • Impaired circulation

24. Alterations in GI Function • Decreased GI acidity • Constipation • Changes in appetite • Role of dental problems • Diverticulosis • Colon cancer • Self management of colostomy

25. 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

26. Alterations in MS Status • Osteoarthritis • Rheumatoid arthritis • Osteoporosis • Falls • Fractures: vertebral, pelvis, hip, shoulder, wrist • Normal: decreased muscle mass, less elastic, shrinking height

27. Interventions for MS • Diet, calcium, vitamin D • HRT: estrogen • Exercise • Safety measures • Hazards of immobility • Identification of appropriate activities • Fall prevention & home safety

28. Risk Factors for Falls • Sensory deficits • Cardiac contributors • Neurological • Urological • Pharmacological • Alcohol • Environment • Fall history

29. 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 Interventions for Falls