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