NSG 2113 Study Guide - Final Guide: Gerontological Nursing, Basal-Cell Carcinoma, Renal Function
18 Dec 2016
School
Department
Course
Professor
Healthy Aging
● Older age starts at 65 but each person ages in their own way and does not necessarily reflect chronological age
● 65-74 = young old, 75-84 = middle old, 85-99 = old old, 100+ = centenarians, 110+ = super centenarians
● Seniors are the fasted growing age group in Canada (14.8% in 2011 and is still increasing)
● Increase is due to the extension of the average lifespan (now 80.4 with women living 4.7 years longer)
● Ratio of older to younger Canadians is increasing
● Baby boom generation is also aging (born 1946-1964)
● By 2031, all baby boomers will reach 65 and the population of older adults will be 23%
● The number of centurions has increased too
● Health care system needs to expand to accommodate
● Many older adults are immigrants
● Aboriginal elderly is a small percentage of the total, but expected to increase
● Nurses in elderly practice must be conscious of cultural views (ex. Preferred food, music, religion)
● Nurses must use attentive listening, use of assessment norms for the age group, asking about personal experiences, family history, previous
health problems, and spiritual resources
● Greatest challenge is finding ways to maintain quality of life
● Variability:
o Senior citizens vary widely in the psychological, physical, and cognitive abilities
o Most older adults live in private homes (not nursing homes)
o Most older adults live very actively and independently without disability, despite chronic disease
o Chronic conditions add to the complexity of older adult care
o 91% of adults report 1+ chronic conditions
o elderly have reduced ability to respond to stress, experience many losses, and are coping with a dynamic changing process
o strengths and abilities (rather than just deficits and weaknesses) must be identified during assessment
● Terminology:
o Geriatrics – medicine that deals with physical, and psychological aspects of aging (diagnosing, treating)
o Gerontology – the study of the aging process and consequences
o Gerontological nursing – the assessment of the health and functional status of older adults (ADPIE)
o Gerontic nursing (rarely used term) – the art and practice of nurturing, caring, and comforting older patients, NOT just the
treatment of disease
● Myths/Stereotypes:
o Ill and disabled → though there is a lot of chronic disease, only a small amount of older adults describe their health as poor
o Not interested in sex → many older adults continue sexual relationships
o Forgetful/unfriendly/unable to understand new info/etc. → older adults have an optimistic outlook, good memories, social
interests, and tolerance for others
o Unattractive/worthless/old fashioned → contribute to ageism
o Ageism – the discrimination against people because of increasing age; undermines self-confidence of adults
o **using singsong voice, simpler sentences, slower, limited vocab, paraphrasing, pet names, “we”
o A society that values the older adults helps them retain function to the greatest extent
o *use teaching techniques that take into account some sensory deficits
● Nurses’ Attitudes:
o Nurses must show positive attitudes and specialized knowledge about aging
o Negative attitudes from health care providers show lack of respect and don’t involve them in planning care activities
o Some treat elderly as objects, not people
o Attitudes are based on personal experience, culture, education, media, increased need for geriatric nursing, education
● Theories:
o Biological
▪ Stochastic – the result of random cellular damage over time which leads to the physical changes of the aging process
▪ Nonstochastic – genetically programmed physiological mechanisms in the body control aging
o Psychosocial – explain changes in behaviour, roles, and relationships with aging; often fail to consider many aspects of aging
▪ Disengagement theory (oldest) – aging ppl withdraw from roles and engage in more introspective, self-focused
activities as societies disengage from them
▪ Activity theory – continuing activities from middle adult hood is necessary for successful aging
▪ Continuity/developmental theory – personality remains the same and behaviour is more predictable, which then
determines degree of activity as well
▪ Gerotrancendence theory – older adults deal with aging by focusing on older and existential ideas
o Theories are closely linked to the developmental tasks for stages of life (losses of health, partners, sense of being useful,
socialization, income, and independence)
o The way an older adult copes with these losses is very individual
● Aging Well – when they achieve self-integration of all aspects of growing older and maintain their quality of life
o Important: existential issues and relationships
o Make decisions with adult to improve quality of life (very subjective)
● Community/Institutional Health Care Services:
o Ex. Private homes, apartments, adult day care centres, assisted-living facilities (supportive housing)
o Long term care facilities provide support services and 24 hour nursing care for those that need assistance but do not need
hospitalization; residents live independently
o Personal care home – private business that provides accommodation, meals, supervision, assistance in a family like atmosphere
o Assisted living facilities – no nursing care
o Palliative/hospice care – care of adults who are dying
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● Assessing Needs:
o Canadian Gerontological Nursing Association → developed standards to define the uniqueness and scope of gerontological
nursing
o Thorough assessment requires you to actively engage older adult to share important info; often takes more time because healthhx
is more complex
o Sensory changes (vision, hearing) also alter data collection
o Memory deficits affect the accuracy and completeness of the data; consult another family member or a caregiver
o Use interpreters if the patient speaks a different language
o Signs and Sx may be different than a younger patient due to age related changes, chronic conditions, coexisting acute conditions,
homeostatic mechanisms, etc.
o Lab values increased → alkaline phosphate, cholesterol, triglycerides, glucose, uric acid
o Lab values decreased → calcium, creatinine kinase, creatinine clearance
o Assess physical, cognitive, and psychosocial aspects
o 5 key points
1. interrelation between physical and psychosocial
2. effects of disease and disability on function
3. decreased homeostatic mechanisms
4. lack of standards for health and illness norms
5. altered manifestations of responses to diseases
o falls are complex events and must be investigated thoroughly
o dehydration is a common problem in older adults because thirst response is reduced
o loss of appetite is common with many diseases
o physiological changes
▪ older adult’s concepts of health generally depend on personal perceptions of functional ability and ADLs
▪ physiological changes are not always pathological but do make elderly more vulnerable
▪ general survey → quick head-to-toe at beginning of encounter; note affect appropriate, common aging changes,
changes in body mass and bulk
▪ integumentary → skin loses resilience and moisture, loses elasticity and gets wrinkly, with lesions and spots (senile
lentigo)
● must rule out 3 malignancies of sun exposure: melanoma, basal cell carcinoma, and squamous cell carcinoma
▪ head and neck → facial features are more pronounced because of loss of fat; may appear asymmetrical because of
missing teeth
● visual acuity declines, presbyopia is common, dark adaptation is reduced
● presbycusis – common age change in auditory acuity, a decrease in the ability to hear high pitched sounds
and sibilant consonants (“s”, “sh”, “ch”)
● taste buds atrophy and lose sensitivity, less salivation
▪ thorax and lungs → respiratory muscle strength decreases, diameter of the thorax increases, osteoporosis, dorsal
kyphosis (dowager’s hump), calcification of costal cartilage (stiffness causes lung expansion to decrease)
▪ heart →
▪ decreased contractility, bp elevated (*note: NOT a normal aging change), peripheral pulses are weaker
▪ breasts → breasts sag b/c of decreased muscle mass, elasticity, and tone,
▪ GI/abdomen → increase of fat, becomes more protuberant, slower peristalsis and secretions
▪ Reproductive system → changes occur with hormone alterations
● Menopause – related to reduced responsiveness of ovaries to hormones therefore decrease in estrogen and
progesterone
● Men – fertility does not stop with aging, though does decline
● Libido is not effected but sexual activity is reduced due to other factors
▪ Urinary → hypertrophy of prostate, urinary incontinence
▪ MSK → muscle fibers reduce in size, bone mass declines
● Exercise and calcium supplements will help reduce
▪ Neuro → decrease in neurons causes changes in sensory, and movement, and sleep
o Functional changes
▪ Some deny changes and continue to expect the same of themselves, unrealistically
▪ Some overemphasize changes and prematurely stop activities
▪ Fear of becoming dependent
▪ Promote effective coping and lifestyle adjustments
▪ Functional status – the capacity and safe performance of ADLs and is an indicator of health
▪ Functional assessment should be followed by nursing interventions that help to maintain, restore, and maximize the
older adults function so they can maintain dignity
o Cognitive changes
▪ Forgetfulness is not expected in aging
▪ Structural and physiological changes in the brain are common with aging but do not necessarily cause cognitive
impairment
▪ Sx of cognitive impairment should be addressed and investigated
▪ 3 common conditions → delirium, dementia, and depression
▪ delirium – acute confusional state; fluctuations in mood, attention, arousal, and self-awareness
● Sx (very sudden) → hallucinations, incoherent speech, disturbed sleep, disorientation,
● acute, reversible
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● physiological cause (ex. E imbalance, anoxia, hypoglycemia, medications, tumours, hematomas, pain,
infection, hemorrhage, pneumonia, UTI etc.)
● environmental cause (ex. Sensory deprivation, unfamiliarity)
● psychosocial cause (ex. Emotional distress, pain)
● especially at risk in acute care setting
● use Confusion Assessment Method to treat risk factors
▪ dementia - the loss of memory, judgement and reasoning and changes in mood, behaviour, and communication
● slowly progressive and irreversible
● with any form of dementia, consider needs of pt and family (physical, safety, psychosocial)
● most challenging behaviours are verbal and physical aggression; must handle this with patience and
reassurance
o DO NOT use restraints, only as a last resort
● 5 types
1. Alzheimer’s - amnesia, agnosia, apraxia, aphasia, incontinence (late); medications prescribed to slow down
the breakdown of Ach by cholinesterase
2. Lewy body disease - dementia, fluctuating cognition, hallucinations, and motor features of parkinson’s
3. frontotemporal dementia - insidious onset; Sx include poor hygiene, lack of social skills, hyperorality, sexual
disinhibition, incontinence (early), and repetitive behaviours
4. Creutzfeldt-Jakob disease - sudden rapid and fatal onset of memory loss, behaviour changes and difficulties
with speech and movement caused by infectious prions that attack nervous system
a. classical AKA sporadic/random
b. variant AKA mad cow disease
5. vascular dementia - interruption of blood supply to areas of the brain by thrombus, embolus, hemorrhage, or
ischemia and may either be stepwise or progressive *similar to CVD
a. use of nicotine is linked to vascular dementia
▪ depression - reduced happiness, wellbeing
● 15-20% elderly
● causes physical and social limitations and complicates treatment
● suicide risk
● more likely to talk about feeling “blue” or sad and do express feelings of diminished satisfaction with life
● delirium and depression are often mistaken for irreversible dementia b/c both cause cerebral dysfunction and
cognitive impairment
o psychosocial changes
▪ involve roles and relationships (ex. becoming grandparents, children becoming caregivers)
▪ assess the status of family, intimate relationships, occupation, finances, housing, social networks, activities, and
spirituality
▪ retirement
● most retired BUT some still employed, part time employed, or employed after initial retirement
● sometime mistaken for passivity and seclusion
● problems occur with social isolation and finances; people who plan in advance have a smoother retirement
● one of the main turning points in life
● personal identity related to work role is lost and a new one needs to be constructed
● most powerful predictors of positive transition are health status, sufficient income, and the option to continue
to work
▪ social isolation
● isolation can be voluntary or involuntary in response to conditions (ex. geographical dispersion)
● living alone and having chronic illness also influence, also SES, institutionalized, etc.
● help by rebuilding social networkds and reverse isolation via outreach programs, social service agencies, and
community programs (ex. church)
▪ abuse - mistreatment of an older adult by people they trust or people who have power and responsible for adult’s care
● neglect → common, intentional or unintentional
● physical abuse → use of physical force that can cause injury or impairment
● sexual abuse → nonconsensual sexual activity, adults who are not able to give consent
● psychological/emotional abuse → infliction of anguish, emotional pain, or distress via language
● financial abuse → illegal or exploitation of funds, assets, property
● self-neglect → behaviour of the senior threatens their health and safety (ex. not eating)
▪ sexuality
● sexuality is important and is linked to identity and validation via intimacy
● provide discussion about sexual activities and info about STIs
● libido does not decrease but frequency does
● some use prescription meds to increase libido or have medications whose side effects are decreased libido
● touch may be used as an alternative to sexual activity though not always appropriate
▪ housing and environment
● changes in living arrangements are caused by changes in function and do require adjustment
● most find appropriate housing (subsidized, community homes, with families, etc.) but some are homeless do
to low income
● environment is a huge influence on functioning
● environment aspects may help to compensate for decreased sensory functioning (ex. using colours that older
people are able to see better)
find more resources at oneclass.com
find more resources at oneclass.com
Document Summary
65-74 = young old, 75-84 = middle old, 85-99 = old old, 100+ = centenarians, 110+ = super centenarians. Seniors are the fasted growing age group in canada (14. 8% in 2011 and is still increasing) Increase is due to the extension of the average lifespan (now 80. 4 with women living 4. 7 years longer) Older age starts at 65 but each person ages in their own way and does not necessarily reflect chronological age. Ratio of older to younger canadians is increasing. Baby boom generation is also aging (born 1946-1964) By 2031, all baby boomers will reach 65 and the population of older adults will be 23% The number of centurions has increased too. Health care system needs to expand to accommodate. Aboriginal elderly is a small percentage of the total, but expected to increase. Nurses in elderly practice must be conscious of cultural views (ex.
