Assignment: Clinical Guide for the Older Adult
Purpose: The purpose of this assignment is to have the student develop a clinical tool with specific information pertaining to the older adult. This information is to cover age-related changes for the specific systems, significance of this changes, and the nursing implementation related to the changes. In addition, the information in the tool should assist the student in preparing for the final.
1. The template below should be used to organize the materials.
2. The bold headings should provide direction as to the content that is expected.
3. It will be appropriate to include simple charts or pictures to assist in addressing the written content. Keep the information clear and concise, bullet may be used.
4. There are 19 topic areas; 15 need to be completed for this assignment. In using the template, skip the topics not addressed, don’t try to delete them. Deleting may alter the remaining format and make it difficult to grade
5. Work should be in your own words. Be specific and give examples. (ex. foods rich in calcium-broccoli, milk, spinach)
6. Suggested resources: Gero textbook and Adult Health 1 textbook especially for age related changes and significance.
7. At the end create a reference page of the sources use. You do not need to reference in the tool itself.
|Falls and the Older Adult (Ch. 11)
|Age-Related Changes in the Older Adult
|Physical Changes Related to Risk of Falling
|Cause of Falls
|Intrinsic Risk Factors:
· Incidence of fall increases with age.
· Living alone.
· Gender- older women fall more than men and they are likely to undergo fractures.
· Nutritional factors- malnutrition portraying as a low body mass index increasing fall rate.
· Visual impairments- glaucoma, cataracts, and other eye diseases interfere with vision hence resulting in increased rates of falls.
Extrinsic Risk Factors:
· Environmental hazards such as slippery flow and poor lighting.
· Inappropriate walking aids.
· Patients on benzodiazepines have an increased risk of falling and fracture due to drowsiness.
· Sedatives, diuretics, anti-arrhythmic medication and psychotropics increase risk of falls.
|· Most of the older adults have experienced falls at their homes or hospitals.
· Most of these falls are associated with preventable causes.
· Elimination of risk factors increases the cases of falls among the elderly which might result in other complications such as damage of other organs.
|· Provision of additional physiotherapy reduces the rate of fall.
· Lowering of beds especially in older patients having psychiatric conditions and also post-surgery.
· Vitamin D supplementation aids in increasing the risk of fall.
|Consequences of Falls
|Physical Injury: hip fractures, fractures of the humerus, pelvis and forearm, and osteoporosis. Others include bruising, lacerations, and superficial wounds.
Psychological Trauma: For the old, the falls generate fear of a reduction in the function capacity. For the family, a fall can indicate need for continuous hospitalization.
|Symptoms to lookout during obtaining a fall history:
Musculoskeletal- joint pain, injuries, muscle weakness and swelling.
Neurological- visual impairment
Gastrointestinal- abdominal tenderness, organomegaly
|Influences on Quality of Life
|Oral Health (Ch. 9)
Intrinsic Risk Factors:
· Nutritional factors- consumption of foods rich in sugar increases the risk of dental caries in the elderly patients. Sugars have also been shown to dissolve the enamel.
· Poor oral hygiene may result in gum infections and tooth decay among the elderly. This occurs due o build up of oral bacteria.
Extrinsic risk factors:
· Increased tobacco use increases the likelihood of oral cancer and gum disease.
· Alcohol abuse is common in the elderly and often results in oral diseases such as oral cancer.
· Gingivitis in the elderly is linked to many various drugs such as calcium channel blockers, and phenytoin.
· Xerostemia is associated with antihistamines, antipsychotics and antidepressants.
· Swelling of lips- attributed to the usage of NSAIDS to manage pain common in the elderly.
· Poor oral health in the elderly has been linked with development of other diseases such as heart diseases. Other conditions resulting from poor oral health are darkened teeth, dry mouth, gum disease, diabetes and pneumonia.
· Nurses are expected to aid the elderly in oral health care. They do this by reminding the elderly to brush their teeth and take medication meant to manage various dental conditions.
· Moreover, they advice the elderly on the recommended diet for healthy teeth such as calcium present in broccoli and spinach, and avoiding sugar rich diets.
|Nutrition (Ch. 9)
|Age-Related Changes: (Biologic, psychological, social factors)
· Older people are prone to malnutrition. Malnutrition incorporates both under-nutrition and over-nutrition.
· Most elderly people do not eat enough food leading to them experiencing cachexia.
· Over-nutrition occurs when older people continue to eat as they used to but remain physically inactive hence resulting in risk of obesity.
· Older people leave alone and do not enough funds for acquiring a balanced diet thus resulting in theme mission some vital minerals.
· Older people conform to the social norms such as engaging in binge drinking and consumption of a lot of red meat and cholesterol containing product putting them at risk of developing lifestyle disorders such as hypertension.
· Older patients have been shown to have chronic disease such as hypertension, diabetes and heart diseases.
· Consumption of grapefruit juice with drugs such as artovastatin increases the rate of their absorption thus increasing their likelihood of causing side effects.
· Grapefruit juice also interferes with cytochrome enzymes involved in drug metabolism resulting in accumulation of drugs such as calcium channel blockers.
· For diabetics, consumption of alcohol prolongs the duration of action of insulin leading to low levels of blood sugar.
· Dairy products also decrease the absorption of antibiotics through chelation.
· Most of the diseases older people develop are linked to the meals they consume.
· Eating foods rich in cholesterol has been shown to cause the deposition of fat in the blood vessels resulting in atherosclerosis and heart conditions.
· Consumption of alcohol has also been linked with development of various neoplastic changes in the body.
· Develop a diet plan, in collaboration with nutritionists, for the older patients.
· Ensure that the nurses feed and do not skip meals.
· Monitor foods and drugs for any food-drug interaction.
· Advice the family members and older patients regarding balanced diet and the importance of taking a balanced diet.
|Sleep &Activity (Ch. 10)
Intrinsic risk factors:
· Illnesses such as schizophrenia, depression, cancer, and stroke affect the sleeping cycle.
· Nutrition-intake of caffeine drinks before bedtime causes insomnia among the elderly.
· Stress and anxiety regarding family has been linked with the interference of the sleep wake cycle in the older people.
Extrinsic risk factors:
· Lighting in the bedroom impacts the sleeping pattern since very bright bedrooms hinder the sleeping process among the elderly.
· Environmental hazards such as noise pollution affect the sleeping patterns in the elderly.
Drugs that Impact Sleep:
· Some drugs promote sleep while others prevent sleep.
· Some antihistamines that cross the blood-brain barrier such as chlorpheniramine promote drowsiness.
· Anticonvulsants such as benzodiazepines result in drowsiness via encouraging the binding of GABA to GABA receptors hence opening the chloride channels thus leading to slowing of the action potentials.
· Antiemetics and beta-adrenergic blockers.
· Caffeine and adrenergic stimulants reduce drowsiness and sleeping durations.
· Sleep disturbances illustrate underlying illnesses, usage of various medication and poor lifestyle practices among the older people.
· It is vital to manage the sleeping patterns since some of the elderly still operate machinery such as their vehicles and drowsiness may result in accidents.
· Sleep deprivation increases risk for mental illnesses, heart disease, stroke and hallucinations.
· Determining the patient practices affecting the sleeping schedule. Administration of sleep medications for the older patients having insomnia.
· Collaborating with the family members to create a bedtime routine for the older patients.
· Educate the older patients regarding meals and medications that interfere with the sleep patterns.
|Safety Topics: Within the Home, Seasonal, Automobile, Living Alone
|Sexuality (Ch. 12)
· Advancement in age results in a changes in sexual activity of both males and females.
· Males experience a reduction in testosterone with the advancement of age. This results in reduction of libido and sexual interest.
· Women experience a reduction in the lubrication of the vagina and thinning of the epithelium of the vagina. This results in dyspareunia.
Drug Impacting Function:
· Selective serotonin reuptake inhibitors have been lined with sexual dysfunction.
· Mirtazepine, bupropion, nefadozone have all been linked with erectile dysfunction.
· Neuroleptic medications result in antagonism of testosterone and reduce libido.
Conditions Impacting Function:
· Various conditions affect sexual activity in the old such as depression, lower urinary tract infections, diabetes, diabetes and erectile dysfunction.
· Most of the elderly patients are on many medications which can reduce the production of hormones such as testosterone which are vital in sexuality.
· Drug-drug interactions need to be considered for patients who are still sexually active.
· Nurses can offer education and counseling regarding meals that boost the libido in the elderly such as watermelons, almonds, strawberries and avocadoes.
· Moreover, they can administer various drugs whose effects will lead to enhanced sexual libido.
· These drugs would include phophodiesterase inhibitors, yohimbine and L-arginine.
|Pain (Ch. 13)
· The incidence of chronic diseases is old people as compared to the young.
· Chronic diseases have been linked with chronic pain hence old people experience more chronic pain.
· In the old, pain is constant, of moderate to severe type, multifocal and multifactorial.
· The commonest cause of pain in the old is cancer, fibromyalgia, diabetic peripheral neuropathy and spinal canal stenosis.
· Pain affects about 50% of adults living at home and 80% of those in nursing institutions.
· The commonest reported symptom in the old in pain.
· Pain reduces the quality of life especially in patients having chronic diseases such as cancer.
Nursing Implications include Non-Pharmacologic and Pharmacologic Interventions
· Non-pharmacological include cognitive-behavioural strategies such as relaxation exercises, hot or warm compression, and distraction techniques.
· Pharmacological interventions include usage of NSAIDs such as meloxicam, opioid analgesics including tramadol, and local anaesthetics such as lignocaine.
|Infection & Inflammation (Ch. 14)
· Levels of inflammatory mediators such as interleukin-1 , interleukin- 6 and tumor necrosis factor alpha increase with increase in age.
· Inflammation is attributed to various mechanisms such as redox stress, mitochondrial damage, immunosenescence, endrocrinosenescence, and epigeneitc modifications.
· The risk of infection is high. Various factors account for this in the old including
· Reduction in immunity can also be attributed to various drugs such as antibiotics, anticonvulsants, antithyroids, and analgesics.
· There is a reduction in immunity among the old since the process of leukopoiesis is decreased.
· Moreover, for those patients having immunodeficiency, the rate of developing other comorbidities is high.
· Most of the organs involved in acting as defense against disease causing pathogens have reduced efficacy in old age such as the skin.
· Monitoring the lab report of patients regarding the various blood cells as a marker of infection and inflammation.
· Administering of various anti-inflammatory medications to relieve the inflammation.
· Providing patient education regarding medication adherence especially to those patients with immunodeficient diseases such as HIV.
|Integumentary Function (Ch. 17)
· There is a thinner epidermis in the elderly.
· The dermis reduces the regenerative capacity thus leading to slower wound healing.
· Loss of fat by the hypodermis resulting in sagging and thinning of the skin. Reduction in the amount of seat and sebum produced.
· Reduction of sweat leads to intolerance to severe heat in some old patients.
· Poor hydration due to weakening of muscles beneath the skin.
· Certain diuretics, ACE inhibitors and anti-seizure medications result in skin photosensitivity which often cause damage to the skin upon exposure to the sun.
· Skin is the largest organ in the body.
· Involved in many functions such as
· Sense of touch.
· First line of defense against infections
· Protection of internal organs
· Absorption of vitamin D
· Evaluation of the nutritional status of the adult patients- patient should be on balanced diets and fluids.
· Turning and repositioning patients as required.
· Conducting regular head to toe examination of the patients’ skins.
|Sensory Function (Ch. 18)
· Hearing loss has been linked with old age though not in all people.
· The ability to hear high frequency sound decreases.
· Some old people may experience tinnitus.
· Certain chemotherapy drugs affect hearing.
· Aminoglycosides such as gentamicin can also lead to damage of the auditory nerve that hence affecting hearing.
· Vision also diminishes as age advances.
· Old people often develop glaucoma, cataracts, macular degeneration, and diabetic retinopathy which impact vision.
· The ears are responsible for hearing and equilibrium.
· The auditory nerve is vital in transmission of hearing impulses. Damage to the nerve causes hearing loss.
· Obstruction of the lens, deposition of the lens and displacement of the lens all affect vision. Certain drugs such as ethambutol also cause retinitis which affects vision.
|Cardiovascular Function (Ch. 19)
Intrinsic risk factors:
· Age- Increase in age increases the risk of developing cardiovascular diseases.
· Family- history of cardiovascular diseases in a family increases the risk of the older people developing cardiovascular diseases.
· Nutrition- consumption of foods high in cholesterol and salt content increases the risk of developing cardiovascular diseases.
· Physical activity- older people are physically inactive thus making them prone to developing cardiovascular diseases.
· Usage of certain drugs often results in elevated blood pressure such as nicotine, cocaine, TCA’s and cyclosporine.
· Emotional distress from family pressures and tough economic times often results in the older individuals developing anxiety and stress which often results in conditions such as hypertension.
· Lifestyle disorders have been linked to a reduction in the cardiovascular function.
· Among the elderly, most deaths are linked to heart diseases.
· Presence of a decreased heart function results in strict monitoring of diet and medication.
· Carry out examination of cardiovascular function each time the older people visit the facility or during home-based care.
· Advice the older people regarding the diet plan and physical activities aimed at improving the cardiovascular function of the older people.
|Respiratory Function (Ch. 20)
· Various age related changes occur in the respiratory function of the adults.
· They experienced a decrease in gas exchange and peak airflow
· Reduction in lung function measures such as vital capacity.
· Weakening of the respiratory muscles.
· Reduction in the mechanisms of lung defense.
· Most of the changes that occur in the respiratory system due to change in age result in weakening of the immune system.
· Changes that occur to the respiratory system of the old people increase their risk of developing shortness of breath, abnormal patterns of breathing and lung infections.
· Administration of bronchodilators and corticosteroids by nurses for various lung conditions.
· Offer exercise training for the older patients.
· Train patients on diaphragmatic breathing, pursed lip breathing, and inspiratory muscle training.
|Gastrointestinal Function (Ch. 21)
· Reduction in saliva secreted and force generated by jaw muscles results in swallowing and chewing difficulties.
· Reduction of lactase in the small intestine which results in intolerance to milk products.
· Slow movement of contents along the large intestines.
· Excessive growth of bacteria that leads to recued absorption of specific nutrients such as iron, calcium and vitamin b12.
· Reduction in gastrointestinal function results in inactivity that has been linked to constipation.
· Most of the elderly are on pain medications such as NSAIDS which have been linked with ulcers.
· Usage of narcotics in the elderly slows the gastrointestinal tract leading to slow bowel movement.
· Old patients on diuretics are at a risk of developing constipation.
· Administration of medications ordered such as laxatives.
· Diet and nutrition education including encouraging the old patients to consume more fiber.
· Encourage hydration of the patients.
· Educate patients on lifestyle changes such as avoidance of tight fitting clothes and avoidance of alcohol and cigarette smoking.
|Urinary Function Ch. 22)
· There is a decline in the glomerular filtration rate resulting in the accumulation of wastes in the body and production of less urine.
· There are bladder control issues such as urinary incontinence, leakage and urine retention.
· Urinary tract infections.
· Development of chronic kidney disease.
· The renal system is responsible for elimination of wastes from the body.
· It is also involved in the production of erythropoietin involved in erythropoiesis
· It releases rennin that is involved in blood pressure regulation.
· It aids in electrolyte balance.
· A reduction in urinary function often leads to a cascade of various diseases in the body hence the need to monitor and manage decrease in renal functions.
· For those patients with urine retention, maintaining patency of the catheters is done by the nurses.
· In cases of Offering of pelvic floor muscle training.
· Bladder training of patients to control the micturation process.
· Administration of medicines such as solifenacin, mirabegron, oxybutynin, and tolterodine to the patient.
|Musculoskeletal (Ch. 23)
· Changes in gait and posture.
· Less pronounciation of foot arches resulting in loss of height.
· Calcification around the joints.
· Reduction of lean body mass.
· Reduction of muscle tone and rigidity.
· Fat and lipofuscin are deposited in the muscle tissues.
· Many older people suffer from joint diseases such as osteoarthritis which is linked to calcification and mineralization.
· The exercises that the older people engage in should be monitored and done under supervision since some of their bones are brittle and application of excessive force may result in their fracture.
· Most diseases of the musculoskeletal system such as system lupus erythematosus are life-threatening thus the need for proper patient management.
· Provision of occupation therapy to patients.
· Offering physiotherapy sessions to the patients with musculoskeletal issues.
· Monitoring the patients when exercising to prevent straining with might lead to fractures.
· Administration of supplements to older patients such as calcium and vitamin D.
· Other medications can also be administered such as bisphophonates.
|Cognitive & Neurologic Function (Ch. 24)
|Endocrine Function (Ch. 25)
· Endocrine function decreases with age since the hormone receptors become less sensitive over time.
· The levels of various hormones decrease with advanced age. These include testosterone, estrogen, melatonin, and growth hormone.
· Certain hormones remain unaltered in the body even at old age. These include insulin, cortisol, and thyroid hormones.
· Specific hormones may increase in their levels. They include norepinephrine, luteinizing hormone, parathyroid hormone, follicle-stimulating hormone, and epinephrine.
· Increase in age increases the metabolism of glucose leading to a rapid rise in glucose metabolism.
· Various drugs have been shown to interfere with the endocrine functions in the old. They include opioids, barbiturates, alcohol, amphetamines, steroids and tobacco.
· Hormones are released into the bloodstream which travel to various body parts.
· Various activities in the body such as reproduction,, metabolism, are regulated by hormones.
· Reduction in production of the hormones means an underlying illness is affecting the hypothalamus, pituitary gland or the adrenal cortex.
· Monitoring of hormone levels in the older patients.
· Administration and monitoring of hormone replacement therapy in the elderly. However, this is done in gradually beginning with lower doses before increasing the doses.
· Carrying out of various tests such as the thyroid function tests to confirm whether the medication is efficacious.
· Administration of medication such as thyroxine to patients.
|IADLs vs ADLs (Ch. 4)
|IADL (Instrumental Activities of Daily Living)
Significance in Older Adults:
|ADL (Activities of Daily Living)
Significance in Older Adults
|Dementia vs Delirium vs Depression (Ch. 24)
|Changes Related to Dementia:
|Changes Related to Delirium:
|Changes Related to Dementia:
|Changes Related to Dementia:
DeWit, S. C., Stromberg, H., & Dallred, C. (2016). Medical-surgical nursing: Concepts & practice. Elsevier Health Sciences.
Fabbri, E., Zoli, M., Gonzalez-Freire, M., Salive, M. E., Studenski, S. A., & Ferrucci, L. (2015). Aging and multimorbidity: new tasks, priorities, and frontiers for integrated gerontological and clinical research. Journal of the American Medical Directors Association, 16(8), 640-647.
Hinkle, J. L., & Cheever, K. H. (2018). Brunner and Suddarth’s textbook of medical-surgical nursing. Wolters kluwer india Pvt Ltd.
Miller, C. A. (2009). Nursing for wellness in older adults. Lippincott Williams & Wilkins.
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