The Aging Population

Geri-6016- Section 1
Promoting Wellness
 Decreases quality of life
 Number of functioning nephrons decline Incontinence
 Kidney increases in weight and mass until early
adulthood-then starts to decline
Affects of Medications:
 25% decrease in kidney mass by age 80
Risk Factors:  Antihistamines- direct effect
 Increased age- but not inevitable  Anti-psychotic
 Obesity Some medications cause impairments to
 Smoking functional abilities- interferes with
Fluid intake and dietary factors: bladder control (page 384)
 Lack of adequate water intake can lead to lower urinary
May cause constipation- causative factor
tract irritability
for incontinence
 High intake of food that increases risk for urinary
incontinence- i.e., coffee, tea, alcohol, soda, sugar,
chocolate, hot pepper
Incontinence- cont.
 Transient urinary incontinence- can
be reversed if underlying issue is
treated
 Overactive bladder (OAB)
 Closely related to incontinence
 Bothersome urgency-day and night-
sometimes accompanied by urge
urinary incontinence
 12% of Canadian adults over 65
report experiencing incontinence-
women more likely than men-
postmenopausal factors
 Physical consequences of
incontinence includes
predisposition to falls, fractures,
and pressure ulcers
Psychosocial Consequences of Incontinence
 Frequent toileting can decrease  Anxiety
need for adult ‘briefs’-time  Restricted activity
consuming but more conducive to
 Insecurity
quality respectful care
 Avoid using briefs in anticipation of  Shame/embarrassed
incontinence  Powerless
 Even those who are not incontinent  Withdraw- isolate
may have exaggerated fears of
developing it
 Functional Impairments and Environmental Conditions
 Private receptacle in private area
 Accessibility to facilities
 Ability to get to and use receptacle
 How much time between urge and
need to void
 Cognition balance, mobility,
coordination, visual function and
manual dexterity
 Dementia-depression- stroke- arthritis-
diabetes- delirium
 Any surgery or acute illness that
temporarily compromises cognitive
abilities
 Ability to voluntarily control the urge
 Impaired vision-environmental
obstacles
 Lack of modified facilities- grab bar etc.
 Restraints

 Caused by unrelieved
pressure that damages
the underlying tissue
Factors that increase the risk of
pressure ulcers:
 Confined to bed
 Use of wheelchair
 Medical devices- ears
 Masks
 Orthotics
 Tubing
 Brace
Pressure Ulcers
Braden Scale
 Acute care healthcare practitioners are mandated to
document any skin breakdown when admitted and
during hospitalization
LTC- Braden Scale score on admission
 Every week for 4 weeks
 Then either monthly or quarterly
 Whenever the clients’ condition changes is suggested
Note that the Braden scale may not always predictive of
pressure ulcers
Functional Consequences of PU
 Pain
 Loss of function
 Decreased quality of life
 Pain management is important
 HAPU can double hospital stay
 Risk of infection of the bone or blood (sepsis)
 Increase rates of mortality during hospitalization
Risk Factors- PU Those who are critically ill who develop HAPU have
multiple risk factors- share unique patterns
 Advancing age  Elderly
 Decline of general mental  Immobile
 Inactive
status,
 Dehydrated
 Decreased mobility
 Sedated
 Sensory perception deficits
 Unconscious
 Incontinence
 Anemic
 Skin moisture  Undernourished
 Friction  Mechanically ventilated
Malnutrition Malnutrition of older
adults in hospitals
Poor nutritional status  Socioeconomic
 Older adults require fewer  40%-69%
status
calories  Often undiagnosed
 Essential vitamins and Protein-energy
minerals is reduced malnutrition Conditions associated with
There are additional risk  Most common in malnutrition in LTC
factors- The Canadian diet frail older adults  Depression
 Rich in calories and fat
 Low protein  Intake of calorie and  Immobility
 Deficient in fibre, fish, milk, protein is less than  Difficulty with chewing
and vegetables the amount to meet
or swallowing
 Nutritional deficiencies daily needs (20%—
have a direct connect to 80%) in LTC meet  Cognitive or functional
functional consequences this criteria impairment
Signs and Impact of Malnutrition
 Lethargy
 Weakness
 Unintentional weight loss
 Diminished muscle mass
 Decrease in subcutaneous fat
 Difficulty responding to illness i.e.,
surgery, infection
 Decrease quality of life- food related
activities celebrations rituals
 Mealtimes are considered ‘social’- when
there is no enjoyment at mealtime the
psychosocial aspects of eating are also
impacted
Psychosocial affects of malnutrition
 Changes in mental status- memory
impairment – sometimes considered a
primary dementia BUT affects of nutritional
deficiencies can be reversed if treated
Interprofessional fall prevention programs-
based on settings
 Focus on reducing falls
 Reducing injuries if a fall does occur
 Must identify person at risk for falls
 Heighten staff awareness-use reminders,
cues- chart identification
 Must document risk factors on the
designated assessment guide
 Frequently reassess
 Nurses are responsible for questioning
whether a client would benefit from a
mobility aid or assistive device- referrals
made to physiotherapist
Falls
Approximately 30% of older adults
living in community have experienced a
fall each year
 Ask if the person has fallen in last
year- ask for details of fall
 Gait or balance problems?
 Requires a fall risk assessment-
physical examination, functional
mobility and environmental
assessment
 Medical and medication review
Addressing Fear of Falling
Fear of falling:
Encourage client to express feelings
Provide education and reassurance about the interventions that are being
implemented
Family should be involved in education and reassurance
Those living alone can benefit from a personal emergency response system-
can be reassuring to client
Proper shoes- no skid soles
Assistive devices
Uncluttered environment
References

Textbook: Millers Nursing for Wellness in Older Adults