Chapter 10

Caring for the Older Adult

Demographics #1

 Population growth:
o Percentage of Americans 65 years or older has
increased from 4.1% of the population in 1900 to
13.7% in 2012, with an expected increase to 21% by
2040.
o The 85+ population is projected to increase from 5.9
million in 2012 to 14.1 million in 2040.
 Life expectancy:
o In 1900, life expectancy was 47 years; for a child
born in 2011, it was 78.7 years.

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CDC FAST STATS

 FastStats - Older Persons Health (cdc.gov)

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Demographics #2

 Diversity:

o Racial and ethnic minority groups have increased

from 17% of people 65+ in 2002 to 21% in 2012.

o It is estimated that 4 million older Americans identify

themselves as either gay, lesbian, bisexual, or
transgender.

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Demographics #3

 Marital status and living arrangements:

o In 2013, 71% of older men and 45% of older women
were married and living together; however only 32%
of women 75 years or older lived with a spouse.
o Rate of divorced or separated older persons
increased from 5.3% in 1980 to 13% in 2013.
o Older adults living in institutional settings in 2013
increased with age: 1% for persons 65 to 74 years;
3% for persons 75 to 84 years and 10% for persons
85 years or older.

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Demographics #4

 Income:
o In 2012, households with families headed by persons
65 years or older reported a median income of
$48,957.
o Older adults below poverty level increased from 8.7%
in 2011 to 9.1% in 2012.
o In 2012, older women had a poverty rate of 11%
versus 6.6% of men.
o In 2013, 18.7% of older Americans were working or
actively seeking work.

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Demographics #5

 Health and health care

o Over the past few years the percentage of
noninstitutionalized older adults who assessed their
health as excellent or very good remained at 42%;
gender did not vary, but racial and ethnic minorities
rated themselves lower.
o In 2012, 93% of noninstitutionalized people of age
65 and over were covered by Medicare, and
approximately 56% also had some type of private
insurance. (Medicare) is a medical health insurance
for anyone age 65+ or some people under 65 with
certain disabilities or conditions.

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Communication and Clinical Skills for
Nursing Care of Older Adults

 Changes in mood

o Knowledge of risk factors, signs, and symptoms of

depression

o Knowledge of methods of assessment for depression

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BECK DEPRESSION INVENTORY

 Beck Depression Inventory (BDI) (apa.org)

 Description of Measure: The Beck Depression Inventory (BDI) is a 21-
item, self-report rating inventory that measures characteristic attitudes
and symptoms of depression (Beck, et al., 1961).

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BECK DEPRESSION INVENTORY

 The BDI has been developed in different forms, including several

computerized forms. The BDI takes approximately 10 minutes to
complete, although clients require a fifth – sixth grade reading level to
adequately understand the questions (Groth-Marnat, 1990).

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Communication and Clinical Skills for
Nursing Care of Older Adults #3

 Mobility
o Skills in or referral for training regarding muscle
strengthening, range-of-motion exercises, gait and
balance training, and use of assistive devices
 Elimination
o Ability to assess the effects of incontinence on quality
of life
o Ability to educate regarding bladder training, external
catheters, exercise, weight loss, and protective pants

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Communication and Clinical Skills for
Nursing Care of Older Adults #4

 Nutrition

o Assessment skills related to diet, poor dentition,

medication side effects, depression, chronic illness
and financial/environmental factors

o Teaching strategies related to adverse effects of

obesity and poor caloric intake

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Communication and Clinical Skills for
Nursing Care of Older Adults #5

 Loss and grief

o Assessment skills related to losses related to health,

significant others (spouses, family, friends, pets),
finances, familiar locations and leisure activities

o Skills needed to assist in exploration of resources and

mechanisms to sustain integrity and dignity during
loss and grief

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Strategies for Maintaining Optimum
Health in Older Adults #1

 Fall prevention
o Falls are the leading cause of both fatal and nonfatal
injuries.
o Avoidance of inappropriate polypharmacy.
o Having routine eye examinations.
o Using muscle strengthening exercises.
o Reducing environmental hazards (throw rugs and
clutter).

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Strategies for Maintaining Optimum
Health in Older Adults #2

 Nutrition
o Food intake declines with age.
o Balanced nutrition has been linked to healthy
immune function and increased quality of life.

 Mobility
o Being physically active lowers risk of some diseases,
reduces depression symptoms, improves thinking,
and increases or maintains strength and balance.

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Strategies for Maintaining Optimum
Health in Older Adults #3

 Sleep and rest

o A healthy older adult may awaken as many as four
times during the night.

o Practice of good sleep hygiene can improve sleep

initiation and maintenance, for example, avoiding
exercise, large meals, alcohol, caffeine, and
technology use before bedtime.

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Strategies for Maintaining Optimum
Health in Older Adults #4

 Immune function
o Routine health examinations and screening can
uncover early health problems.
o Routine screening should be performed for breast
cancer, colorectal cancer, diabetes, lipid disorders,
and osteoporosis.
o Vaccinations should include annual influenza
vaccinations and pneumococcal vaccinations every 5
years.

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Strategies for Maintaining Optimum
Health in Older Adults #5

 Pain management
o Pain can result in decreased quality of life by
increasing the chance of depression and suicidal
ideation, by decreasing chances for socialization and
by decreasing appetite.

o Good pain management includes appropriate use of

medication and therapies such as distraction
techniques, meditation, massage and acupuncture.

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Functional and Physiologic Changes in
Older Adults #1

 Cognition and communication

o Cognitive changes may include: losses in attention

span, short-term memory.

o Language deficits also may occur, which impair

communication.

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Functional and Physiologic Changes in
Older Adults #2

 Mood

o Mood disorders, especially depression, are often

unrecognized or misdiagnosed in older adults.

o Currently, older white men have the highest rate of

suicide in the United States.

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Functional and Physiologic Changes in
Older Adults #3

 Mobility

o Musculoskeletal or neurologic conditions may cause

hemiparesis (weakness on one side of the body),
ataxia (impaired muscular coordination), spasticity
(stiff or awkward muscle movements), and
coordination or balance problems.

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MOBILITY

 Mobility scooter
 Walker
 Wheelchair
 Cane’s/crutches
 Stairlifts
 Shoes
 Wheelchair ramps

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Functional and Physiologic Changes in
Older Adults #4

 Elimination

o Urinary incontinence is not considered a normal part

of aging; it can be associated with chronic conditions
such as diabetes, stroke, mobility and cognitive
impairments, and infection.

o Common types of incontinence seen in older adults

are urge incontinence and stress incontinence.

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Functional and Physiologic Changes in
Older Adults #5

 Skin integrity

o Intact skin and healthy skin integrity usually are

maintained well into older adulthood.

o Malnutrition, dehydration, immobility, or bladder

and/or bowel incontinence without proper skin care
contributes to skin breakdown in older adults.

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Functional and Physiologic Changes in
Older Adults #6

 Nutrition
o Physiological changes that impact nutrition include a
decrease number of taste buds and saliva production
which can decrease appetite.
o Dental problems can make effective chewing difficult.
o Medical conditions more commonly seen in older
adults, such as chronic obstructive pulmonary
disease, also contribute to poor appetite.

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Functional and Physiologic Changes in
Older Adults #7

 Immunity

o Humoral immunity declines because of changes in T-

cell function.

o Older adults have lower antibody response to

microorganisms that cause influenza and pneumonia.

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Functional and Physiologic Changes in
Older Adults #8

 Sleep and rest

o Stage 1 sleep increases and deep sleep decreases,
leading to more frequent nighttime awakenings and
less restful sleep.

 Sexuality
o Men and women experience changes that affect
certain aspects of sexuality, such as arousal and
orgasm.

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Myths About Physiological Changes in the
Older Adult

 “Cognitive decline is inevitable with age.”

o Many older adults retain full cognitive function into
advanced age.
 “Depression is expected as one gets older.”
o Depression is not a normal part of aging.
 Most older adults, especially men, experience urinary
incontinence.
o Urinary incontinence is not considered a normal part
of aging.

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