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Chapter 2

Common Health Problems


of Older Adults

Copyright 2016, 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.

Subgroups of Late Adulthood


Young old 65 to 74 years
Middle old 75 to 84 years
Old old 85 to 99 years
Elite old 100 years +

Copyright 2016, 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.

Health-Protecting Behaviors

Vaccinations

Influenza
Pneumococcal
Shingles
Tetanus (booster every 10 yr)

Seat belts
Moderate alcohol

Copyright 2016, 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.

Health-Protecting Behaviors (Cont.)


No smoking
Smoke detectors/sprinklers in home
Medications, herbs, supplements as
prescribed
Avoid over-the-counter medications unless
prescribed
Hazard-free environment

No scatter rugs, waxed floors

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Common Health Issues & Concerns


Decreased nutrition and hydration
Decreased mobility
Stress and loss
Accidents

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Common Health Issues & Concerns


(Cont.)
Drug use and misuse
Mental health/cognition problems (including
substance abuse)
Elder neglect and abuse

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Causes of Malnutrition
Sedentary lifestyle
Reduced metabolic rate
Reduction in total caloric intake
Inappropriate/unbalanced foods for
example, desserts/sweets
Diminished sense of taste, smell
Tooth loss, poorly fitting dentures

Copyright 2016, 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.

Causes of Malnutrition (Cont.)


Reduced income
Chronic disease, fatigue
Decreased ability to perform ADLs
Fast food consumption that leads to obesity
Inability to carry large or heavy groceries
Loneliness

Copyright 2016, 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.

Geriatric Failure to Thrive (GFTT)

Complex syndrome:

Under-nutrition
Impaired physical functioning
Depression
Cognitive impairment

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Benefits of Regular Exercise


Decreased risk for falls
Increased mobility
Increased sleep
Reduced or maintained weight

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Benefits of Regular Exercise (Cont.)


Improved well-being and self-esteem
Decreased depression symptoms
Improved longevity
Reduced risk for DM, CAD, and dementia

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Types of Exercise
Resistance
Aerobic
Chair

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Stress and Loss


Rapid environmental changes
Changes in lifestyle
Acute or chronic illness
Loss of significant other
Financial hardship
Relocation (especially relocation stress
syndrome)

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Accidents
Fall prevention
Driving safety

Most common cause of injury-related death, ages


65-74
Health problems and medications can contribute
to risk factors

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Improving Driving Safety


Assess physical/mental deficits
Discuss driving concerns with patient
Recommend strategies for maintaining safety
when driving

Driving refresher courses


Avoid high-risk conditions for example, wet
roads
Use vehicle safety features for example, largeprint digital readouts

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Drug Use and Misuse


Polymedicine, polypharmacy, hyperpharmacy
Intolerance to standard drug dosages
Physiologic changes affect absorption,
distribution, metabolism, excretion

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Effects of Drugs
Often intolerant of standard doses
Age-related changes:

Affect absorption
Affect metabolism
Reduce liver blood flow and serum enzyme activity

Changes in kidneys result in high plasma


drug concentrations

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Creatinine Clearance Test


Measures glomerular filtration rate of kidneys
(140 age in years) body weight in kg
serum creatinine in mg/dL 72
= Creatinine Clearance in Men
Creatinine Clearance in Men 0.85 = Creatinine Clearance in Women

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Self-Administration of Drugs

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Medication Assessment
& Health Teaching
Assess medication use per Healthy People
2020 recommendations
Highlight all drugs that are part of Beers
criteria
Assess for duplicate drugs
Collaborate with patient, family, pharmacist,
and primary health care provider

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Medication Assessment
& Health Teaching (Cont.)
Give verbal and written information
Promote adherence to drug therapy regimen
exactly as prescribed
Encourage lifestyle changes and
nonpharmacologic interventions
Remind not to share/borrow drugs

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Mental/Behavioral Health Problems

Legal competence

18 yr or older
Pregnant or married minor
Legally emancipated
Not declared incompetent by a court of law

Clinical competence: Person is legally


competent, can make clinical decisions

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Increased Risk for


Cognitive Health Problems

3 Ds

Depression
Delirium
Dementia

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Depression
Mood disorder having cognitive, affective,
physical manifestations
Primary (lack of neurotransmitters)
Secondary or situational (illness or loss)
Geriatric Depression Scale Short Form
(GDS-SF) used for assessment
Treatment includes drug therapy,
psychotherapy
Reminiscence or reflective therapies useful
with older adults

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Dementia
Syndrome involving slow, progressive
cognitive decline (also known as chronic
confusion)
Global impairment of intellectual function;
generally chronic and progressive
Types

Alzheimers disease
Multi-infarct dementia

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Delirium
Acute state of confusion
Usually short-term; reversible within 1 month
or less
Often experienced by older adults in
unfamiliar settings
Can include physical and emotional
manifestations of change

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Examples of Causes of Delirium


Drug therapy
Electrolyte imbalance
Infections
Metabolic problems
Nutritional deficiencies
Hypoxemia
Major loss

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Screening for Delirium


Confusion Assessment Method (CAM)
Delirium Index (DI)
NEECHAM Confusion Scale
Mini-Cog

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Alcohol Use & Abuse


Increase risk for falls, other accidents
Affect mood, cognition
Leads to complications of chronic diseases
(for example, diabetes mellitus, hypertension,
GERD)

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Short Michigan Alcoholism


Screening Test Geriatric Version
10 yes/no questions
Each yes answer = 1 point
Total score of 2 or more points = individual
has problem with alcohol
Examples of questions:

Do you drink to take your mind off of your


problems?
When you feel lonely, does having a drink help?

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Alcohol Use & Abuse (Cont.)


Isolation, depression, delirium can result
National Institute on Alcohol Abuse and
Alcoholism (NIAAA) recommends no more
than 1 drink/day or 7 drinks/week for people
over 65

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CAGE Test

Four questions:

Have you ever tried to cut down on your drinking?


Have people annoyed you by criticizing your
drinking?
Have you ever felt bad or guilty about your
drinking?
Have you ever had a drink first thing in the
morning to settle your nerves? (eye-opener)

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Elder Neglect and Abuse


Neglect: Caregiver failure to provide basic
needs
Abuse

Physical Use of physical force that results in


bodily injury
Financial Mismanagement or misuse of property
or resources
Emotional Intentional use of threats, humiliation,
intimidation, isolation

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Health Care Issues for Older Adults in


Hospitals and Long-Term Care Settings

Fulmer SPICES framework

Sleep disorders
Problems with eating or feeding
Incontinence
Confusion
Evidence of falls
Skin breakdown

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Restraints
Device or drug that prevents patient from
moving freely
Must be prescribed by health care providers
Avoid use whenever possible in nursing
homes, hospitals
Alternatives to restraints should always be
used first

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Restraints (Cont.)

Chemical

Antipsychotics
Antianxiety drugs
Antidepressants
Sedative-hypnotics

Physical (used when alternative methods and


chemical restraints fail)

Least restrictive device should be used first


Follow facilitys policy and procedures

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Chapter 2
Audience Response System
Questions

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Question 1
An older patient was admitted for a hip fracture
after a fall in his home. On admission to the
hospital, he was alert and oriented. On
postoperative day 1, the patient is confused,
withdrawn, and restless. What condition does
the nurse suspect?
A.
B.
C.
D.

Delirium
Dementia
Depression
Alcohol withdrawal
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Question 2
An 80-year-old patient has been admitted to the hospital
for extreme weakness and difficulty eating. The nurse
conducts a fall risk assessment. Which variable(s)
indicate that the patient is at risk for falls? (Select all
that apply.)
A.
B.
C.
D.
E.

Admission diagnosis of difficulty eating


Admission diagnosis of extreme weakness
Patient reports falling twice within the last month
Family members bring patient several meals weekly
Patient reports wearing glasses for all daily activities

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Question 3
Which subgroup is referred to as the frail
elderly?
A.
B.
C.
D.

65 to 74 years of age (the young old)


75 to 84 years of age (the middle old)
85 to 99 years of age (the old old)
100 years of age or older (the elite old)

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