CARE OF OLDER ADULTS NCMB 214 (PRELIM 2024-2025)

2006).
 By mid-21st century, old people will
Introduction to Gerontological outnumber young for the first time in
history
Nursing In the Philippines, the number of older people
Gerontology is increasing rapidly, faster than growth in the
Ø From the Greek Geron, meaning “old total population. In 2000, there were 4.6
man” and “ology” meaning “study” million senior citizens (60 years or older),
Ø Is the scientific study of the process of representing about 6% of the total
aging and the problems of aged population. In two decades, this has grown to
persons 9.4 million older people or about 8.6% of the
Ø It includes biologic , sociologic , total population. The World Population
psychologic , and economic aspects. Prospects 2019 projects that by 2050, older
Ø Subfields include geriatrics, social people will make up around 16.5% of the total
gerontology, geropsychology, population.
geropharmaceutics, financial
gerontology, gerontological nursing,
and gerontological rehabilitation
nursing.
Geriatrics
Ø From Greek Geras, meaning “old age”
Ø Often used as a generic term relating
to old adults K.T.B 1 of
Ø But specifically refers to medical care
of the aged.
This is why many nursing journals and texts
have
chosen to use the term gerontological nursing
versus
geriatric nursing.
Gerontological Nursing
Ø Aspect of gerontology that falls within
the discipline of nursing and the scope
of nursing practice. Share of aging population the Philippines
Ø This specialty of nursing involves 2015-2100
assessing the health & functional Published by Martha Jean Sanchez, Jan 22,
status of older adults, planning and 2020
implementing health care & services to
meet the identified needs, and In 2015, the share of population older than 65
evaluating effectiveness of such care. amounted to about 4.6 percent. In 2100, the
WHAT IS OLD AND WHO DEFINES OLD percentage of the population above the age
AGE? of 65 was forecasted to reach 25.6 percent.
“Old” is often defined as over 65 years of The share of the aging population was
age, this is an arbitrary forecasted to increase throughout the years.
number set by Social Security Administration Why the increase?
(in case of Americans). P Improved sanitation
Today, the older group is often divided into: P Advances in medical care
 Young old (65-74) P Implementation of preventive health
 Middle old (75-84) services
 Old old, very old, or frail elderly (85 P In 1900s, deaths were due to
and up) infectious diseases and acute illnesses
The number of older people is growing P Older population now faced with new
 In 2005, 13% of the U.S. pop. was over challenge
age 60 Chronic disease
18.3 million aged 65–74 Health care funding
12.9 million aged 75–84 P Average75y/o has 3 chronic diseases&
4.7% aged 85 or older uses 5 types of medications
 This number is estimated to increase: P 95% of health care expenditures for
To 20 million in 2010 (6.8% of total), older Americans are for chronic
To 33 million in 2030 (9.2%), and diseases
To almost 50 million in 2050 (11.6%) P Changes in fertility rates
(National Center for Health Statistics P Baby boom after WWII (1946 –1964)
[NCHS],
 P 3.5 children per household balance the concerns of the patient,
P Older population will explode between family, nursing, and the rest of the
2010 to 2030 when baby boomers interprofessional team.
reach age 65 Advocate
LIFE EXPECTANCY:  As an advocate, the gerontological
Life expectancy is the average number nurse acts on behalf of older adults to
of years that a person can be expected promote their best interests and
to live strengthen their autonomy and
 Philippines : 69 years old decision making.
 US : 75.7 years old Evidence-Based Clinician
 Life Span : 115 years  Gerontological nurses must remain
 Kane Tanaka born 2 January 1903, age abreast of current research literature,
117 years, is the oldest living person in reading and translating into practice
Japan and in the world. the results of reliable and valid studies.
 Francisca Susano, vying for Guinness
record as world's oldest living person
 French women lived for 122 years Theories of Aging
(1994)
Aging is the result of progressive
Major reasons for the lengthening of life
accumulation of changes in the body which
EXPECTANCY are:
occur with passing time and which cause the
a. Better prenatal care
increase in the probability of the disease and
b. Better delivery techniques
death of the individual (Denham Harman).
c. Better medical care
Theories of Aging
d. Better nutrition
Ø Competency of caring for elderly
e. Better use of preventative measures
become more important as a result of
f. A generally higher standard of living
increasing older population in the last
g. More leisure time
decade and expecting to increase in
Feminization of Later Life
the next few years.
 Women comprise 55% of the older
Ø Many theories of aging describes and
population
explain aging process and how
 Women have a longer life expectancy
individuals respond to changes that
 The average life expectancy of women
occur with aging
in the United States is 81 years
Ø By understanding a normal process of
aging, the quality of nursing care for
the elderly maybe enhanced.
CARE OF OLDER ADULTS NCMB 214 Types of Aging Theory
 (PRELIM
The average life expectancy of men in 2024-2025)
the United States is 75.2 years
 Male exposure to risk factors may
account for the differences
 Increases in female exposures to risk
factors will reduce difference in life
expectancy
ROLES OF GERONTOLOGICAL NURSE
Direct- Care Provider
 The nurse gives direct, hands-on care
to older adults in a variety of settings.
 Older adults often present with
atypical symptoms that complicate K.T.B 2
diagnosis and treatment. Thus, the
nurse as a direct-care provider should
Psychosocial Theories of Aging
be educated about disease process
Ø Psychosocial theories attempt to
and syndromes commonly seen in the
explain aging in terms of behavior,
older population.
personality, and attitude change.
Teacher
o Psychological - personality or
 Gerontological nurses focus their
ego development and the
health teachings on modifiable risk
accompanying challenges
factors and health promotion.
associated with various life
Leader
stages.
 Gerontological nurses act as leaders
o Sociological - Discusses how
during everyday practice as they
changing roles, relationships,
 and status within a culture or
society impact the older adult’s CARE OF OLDER ADULTS NCMB
ability to adapt.
Sociological Theories STAGES OF PERSONALITY DEVELOPMENT
ACTIVITY - Remaining occupied and involved – Personality develops in eight sequential
is necessary to a satisfying late-life. stages with corresponding life tasks. The
DISENGAGEMENT - Gradual withdrawal from eighth phase, integrity versus despair, is
society and relationships serves to maintain characterized by evaluating life
social equilibrium and promote internal accomplishments; struggles include letting
reflection. go, accepting care, detachment, and physical
SUBCULTURE - The elderly prefer to and mental decline.
segregate from society in an aging subculture
sharing loss of status and societal negativity
regarding the aged. Health and mobility are
key determinants of social status.
CONTINUITY - Personality influences roles
and life satisfaction and remains consistent
throughout life. Past coping patterns recur as
older adults adjust to physical, financial, and
social decline and contemplate death.
AGE STRATIFICATION - Society is stratified
by age groups that are the basis for acquiring
resources, roles, status, and deference from
others. Age cohorts are influenced by their
historical context and share similar
experiences, beliefs, attitudes, and LIFE- COURSE/LIFESPAN DEVELOPMENT -
expectations of life course transitions. Life stages are predictable and structured by
PERSON-ENVIRONMENT FIT - Function is roles, relationships, values, and goals.
affected by ego strength, mobility, health, Persons adapt to changing roles and
cognition, sensory perception, and the relationships. Age group norms and
environment. Competency changes one’s
ability to adapt to environmental demands.
Psychological Theories
HUMAN NEEDS - Maslow’s Hierarchy of

characteristics are an important part of the

life course.
Biological Theories of Aging
Ø The biological theories explain
information regarding the physiologic
processes that change with aging.
Ø How is aging manifested on the
molecular level in the cell, tissues, and
body systems; how does the body-
mind interaction affect aging; what
biochemical processes impact aging;
Human Needs Theory and how do one’s chromosomes
INDIVIDUALISM - Personality consists of an impact the overall aging process?
ego and personal and collective o STOCHASTIC or statistical
unconsciousness that views life from a perspective, which identifies
personal or external perspective. Older adults episodic events that happen
search for life meaning and adapt to throughout one’s life that cause
functional and social losses. random cell damage and
accumulate over time, thus
causing aging
 o NON-STOCHASTIC theories themselves after they are destroyed by
that view aging as a series of wear and tear.
predetermined events Cells wear out and cannot function
happening to all organisms in a with aging.
time Connective Tissue Theory
STOCHASTIC THEORIES  This theory is also referred to as cross-
Ø Free Radical Theory link theory, and it proposes that, over
Ø Orgel/Error Theory, time, biochemical processes create
Ø Wear and Tear Theory connections between structures not
Ø Connective Tissue Theory normally connected. Several cross-
linkages occur rapidly between 30 and
50 years of age.
 Ex. Elastin dries up and cracks with
age. Hence, skin with less elastin (as
K.T.B 3 with the older adult) tends to be dried
and wrinkled.
Free Radical Theory With aging, proteins impede metabolic
 Aging is due to oxidative metabolism processes and cause trouble with getting
and the effects of free radicals, which nutrients to cells and removing cellular waste
are the end products of metabolism. products.
 Free radicals are produced when the NON STOCHASTIC THEORY
body uses oxygen such as with Ø Programmed theory,
exercise. This theory emphasizes the Ø Gene/Biological clock,
significance of how cells use oxygen Ø Neuroendocrine,
(Hayflick, 1985). Ø Immunologic/Autoimmune theory.
 Free radicals are thought to react with Programmed theory
proteins, lipids, deoxyribonucleic acid  Cells have a finite doubling potential
(DNA), and ribonucleic acid (RNA), and become unable to replicate after
causing cellular damage. they have done so a number of times.
 This damage accumulates over time  Apoptosis is a form of programmed cell
and is thought to accelerate aging. death, or “cellular suicide.” It is
Membranes, nucleic acids, and different from necrosis, in which cells
proteins are damaged by free die due to injury.
radicals, which causes cellular Cells divide until they are no
injury and aging. longer able to, and this triggers
Orgel/Error Theory apoptosis or cell death.
 This theory suggests that, over time,
cells accumulate errors in their DNA
and RNA protein synthesis that cause
the cells to die.
 Environmental agents and randomly CARE OF OLDER AD
induced events can cause error, with
ultimate cellular changes. Gene/Biological Clock (PRELIM 202
 It is well known that large amounts of  This theory explains that each cell, or
x-ray radiation cause chromosomal perhaps the entire organism, has a
abnormalities. Thus, this theory genetically programmed aging code
proposes that aging would not occur if that is stored in the organism’s DNA.
destructive factors such as radiation Slagboom and associates (Slagboom,
did not exist and cause “errors” such Bastian, Beekman, Wendendorf, &
as mutations and regulatory disorders. Meulenbelt, 2000) describe this theory
Errors in DNA and RNA synthesis as comprising genetic influences that
occur with aging. predict physical condition, occurrence
Wear and Tear Theory of disease, cause and age of death,
Ø Over time, cumulative changes and other factors that contribute to
occurring in cells age and damage longevity.
cellular metabolism. Cells have a genetically
Ø An example includes the cell’s inability programmed aging code.
to repair damaged DNA, as in the Neuroendocrine Theory
aging cell. It is known that cells in  This theory describes a change in
heart muscle, neurons, striated hormone secretion, such as with the
muscle, and the brain cannot replace releasing hormones of the
hypothalamus and the stimulating
 hormones of the pituitary gland, which ▸ Environmental conditions
manage the thyroid, parathyroid, and
adrenal glands, and how they influence
the aging process K.T.B 4
Problems with the hypothalamus-
pituitary-endocrine gland
feedback system cause disease; Comprehensive Geriatric Assessment
increased insulin growth factor (CGA)
accelerates aging. ▸ Physical health
Immunologic/Autoimmune Theory ▸ Mental health
 This theory was proposed 40 years ago ▸ Functional status
and says that the normal aging ▸ Social functioning
process of humans and animals is ▸ Environment
related to faulty immunological Functional Status Assessment
function (Effros, 2004). There is a Ø Functional status is considered a
decreased immune function in the significant component of an older
elderly. adult’s quality of life.
Aging is due to faulty Ø Functional status assessment is a
immunological function, which is measurement of the older adult’s
linked to general well-being. ability to perform basic self-care tasks,
Nursing Theories of Aging or ADLs, and tasks that require more
Functional consequences theory complex activities for independent
Environmental and biopsychosocial living, referred to as IADLs.
consequences impact functioning. Nursing’s Ø Determination of the degree of
role is risk reduction to minimize age- functional independence in these areas
associated disability in order to enhance can identify a client’s abilities and
safety and quality of living. limitations, leading to appropriate
Using knowledge gained from aging interventions.
theories, nurses can assist people to: Ø The client’s situation determines the
Ø Use their genetic makeup to prevent location and time when any of the
co-morbidities scales or tools should be administered,
Ø Facilitate best practices for managing as well as the number of times the
chronic illnesses client may need to be tested to enjoy
Ø Maximize individuals’ strengths to ensure accurate results.
relative to maintaining independence Ø Many tools are available, but the nurse
Ø Facilitate creative ways to overcome should use only those which are valid,
individuals’ challenges reliable, and relevant to the practice
Ø Assist in cultivating and maintaining setting.
older adults’ cognitive status and WHO (1980) ICIDH Classification
mental health. Ø Impairment: Any loss or abnormality
Conclusion of a psychological, physiological, or
 Aging continues to be explained from anatomical structure or function.
multiple theoretical perspectives. Ø Disability: Any restriction or lack
Collectively, these theories reveal that (resulting from an impairment) of
aging is a complex phenomenon still ability to perform an activity in the
much in need of research. How one manner or within the range considered
ages is a result of biopsychosocial normal for a human being.
factors. Ø Handicap: A disadvantage for a given
 Nurses can use this knowledge as they individual, resulting from impairment
plan and implement ways of promoting or disability that limits or prevents the
health care to all age groups. fulfillment of a role that is normal
(depending on age, sex, and social and
cultural factors) for that individual.
Nursing Care of Older Adult in Activities of Daily Living (ADLs)
Ø The original ADL tool was developed
Wellness by Katz and colleagues.
Assessment: Ø Katz Index distinguished between
Assess for potential health hazard to independence and dependence in
identify risk factors for illness and injury. activities and created an ordered
Risk Factors: relationship among ADLs.
▸ Habits
▸ Lifestyle patterns
▸ Personal and family medical history
 Ø It addressed the need for assistance in
bathing, eating, dressing, transfer,
toileting, and continence.
Instrumental Activities of Daily Living
(IADLs)
Ø Instrumental activities of daily living
include a range of activities that are
considered to be more complex
compared with ADLs and address the
older adult’s ability to interact with his
or her environment and community.
Tasks Typically Assessed with IADL
Assessment Tools
Ø Using the telephone
Ø Taking medications
Ø Shopping
Ø Handling finances
Ø Preparing meals
Ø Laundry Light or heavy housekeeping
Ø Light or heavy yardwork
Ø Home maintenance
Ø Using transportation
Ø Leisure/recreation

CARE OF OLDER ADULTS NCMB 214 (PRELIM 2024-2025)

Katz Index K.T.B 5
The Katz Index is a useful tool to describe the
client’s functional level. Physical Assessment
Ø Conducting a physical assessment of
an older adult is based on technical
competence in physical assessment,
and knowledge of the normal changes.
Ø Circulatory Function
Ø Respiratory Function
Ø Gastrointestinal Function
Ø Genitourinary Function
Ø Sexual Function
Ø Neurological Function
Ø Musculoskeletal Function
Ø Sensory Function
Ø Integumentary Function
Ø Endocrine and Metabolic Function
PAR-Q AND YOU

Cognitive Assessment
Ø Changes in cognitive function with age
vary among older adults and are
difficult to separate from others.
Ø Generally speaking, older adults
manifest a gradual and modest decline
in short- term memory and experience
a reduction in the speed at which new
information is processed
MiniMental State Examination

Gordon’s 11 Basic Functional Health

Patterns of Older Adult
1. Self-Perception/Self-Concept Pattern
 Ø This pattern encompasses a sense of Ø This pattern encompasses the older
personal identity; body language, adult’s behavioral expressions of
attitudes, and view of self in cognitive, sexuality.
physical, and affective realms; and 11. Elimination Pattern
expressions of sense of worth and Ø This pattern encompasses bowel and
emotional state. bladder excretory functions.
2. Roles/Relationships Pattern Planning
Ø This pattern encompasses the  Exploring older adults’ personal ideas
achievement of expected and beliefs concerning health needs
developmental tasks.  Reading current literature regarding
Ø Basic needs for communication and latest update for specific health
interactions with other people, as well promotion
as meaningful communications and  Current health policy information that
satisfaction in relationship with others will safeguard client rights
are examined.  Understanding and use of behavior
3. Health Perception/Health change theories
Management Pattern Implementation
Ø This pattern encompasses the  Adopting a proactive stance toward an
perceived level of health and current action plan for health promotion of the
management of any health problems. older individual
4. Nutritional/Metabolic Pattern  Activities, locations, and means of
Ø This pattern encompasses evaluation disseminating health promotion
of dietary and other nutrition-related  Annual health promotion screening
indicators.  Program that provide vaccinations for
5. Coping/Stress-Tolerance Pattern older adult
Ø This pattern encompasses the client’s  Screening for cancer , diabetes, and
reserve and capacity to resist other condition
challenges to self-integrity, and his or  Monthly health talks provided in senior
her ability to manage difficult centers
situations.  Housing sites
6. Cognitive/Perceptual Pattern  Continuing retirement communities
Ø This pattern encompasses self-  Advocate and educate about health
management of pain, presence of promotion
communication difficulties and deficits  Safe medication use
in sensory function. Evaluation
 Determining effectiveness of care plan
 Check established goals
 Establish appropriate and realistic
revised goals and realistic steps to
achieve them

CARE OF OLDER ADULTS NCMB 214 (PRELIM 2024-2025)

PHARMACOLOGY AND OLDER ADULTS
7. Value/Belief Pattern Older persons body is at greater risk for
Ø This pattern encompasses elements of adverse drug events than younger persons.
spiritual well-being that older adults • ⬇️In body water (as much as 15%)
perceive as important for a satisfactory • results to increase concentration of
daily living experience and the water-soluble drugs (e. g. alcohol)
philosophic system that helps him or • ⬆️in body fat
her function within society. • ⬇️more prolonged effects of fat-soluble
8. Activity/Exercise Pattern drugs
Ø This pattern encompasses information • hepatic blood flow results in increased
related to health promotion that toxicity
encourages the older adult to achieve = Increased SGP Increased PT, PTT
the recommended 30 minutes daily of
physical activity on most days of the
week. K.T.B 6
9. Rest and Sleep Pattern
Ø This pattern encompasses the sleep • ⬇️serum albumin level
and rest patterns over a 24-hour • altered binding capacity
period and their effect on function.
10. Sexuality/Reproductive Pattern
 • increased serum level of the free or into fatty tissue, resulting in prolonged
unbound proportion of protein- bound half-lives and drug accumulation
drugs Ø HEPATIC METABOLISM
• toxic level of highly bound drugs ü age-related metabolism is not easily
PREDICTORS OF MEDICATION RESPONSE measured.
Ø GENERAL STATE OF HEALTH ü Primarily, biotransformation occurs
Ø NUMBER AND TYPES OF OTHER in liver, where enzymatic activity
MEDICATIONS TAKEN alters and detoxifies the drug to
Ø LIVER (sgpt), RENAL FUNCTION - prepare it for excretion.
Creatinine Ø RENAL EXCRETION
Ø PRESENCE OF COMORBIDITIES OR ü the most important pharmacokinetic
OTHER DIAGNOSED DISEASES parameter that changes with age
MEDICATION ERROR
• Results from human knowledge-based
deficiencies and a lack of sophisticated CARE OF OLDER ADULTS NCMB
systems to support and monitoring
drug therapy. ü changes are extremely variable,
2 IMPORTANT DISTINCTIONS IN majority of older adults have a decline
MEDICATION ERROR LANGUAGE kidney function, requiring a decrease
1. ADVERSE DRUG REACTION (ADR) dose or extension of interval for
• any unintended response to a drug certain drugs
that occurs when drugs are used to ü SERUM CREATININE may be used as
diagnose, treat or prevent disease. indirect estimate of renal function.
• ADR INCLUDES: ü CREATINE CLEARANCE is an estimate
ü Difficulties in the activity of daily of GFR and decreases with age.
living. 2. PHARMACODYNAMIC CHANGES WHAT
ü Cognitive changes THE DRUG DOES TO THE BODY??
ü Falls • Aging may result in different responses
ü Anorexia, nausea for older adults to the same drug
ü Weight changes concentrations at the site of action
2. ADVERSE DRUG EVENT (ADE) compared with younger adults.
• any injury that results when CHANGES IN PHARMACODYNAMICS IN
medications are used, and this OLDER PERSON MAY BE CAUSED BY:
includes both ADR’s and medication • Altered number of receptors or affinity.
errors that lead to an ADR. • Decreases in receptor binding.
• NOTE: the use of too many or wrong • Altered cellular response to the drug
types of medications increases the risk receptor- receptor interaction.
of both an ADE and non-adherence!!!!! • Organ pathologic condition.
FACTORS THAT CONTRIBUTE TO • Altered homeostatic mechanism.
INCREASED RISK OF ADE 3. DRUG-DRUG INTERACTION
1. PHARMACOKINETIC CHANGES: WHAT Ø an interaction between one drug and
THE BODY DOES TO THE DRUG??? another can result from altered
Ø DRUG ABSORPTION pharmacokinetics or
ü Do not usually contribute to drug pharmacodynamics.
response and have less impact on Ø it is largely thought that alterations in
pharmacokinetics. hepatic metabolism are specifically
ü altered distribution into the peripheral responsible for drug-drug interaction.
circulation and tissues • EX: Warfarin and aspirin- increased risk
ü decrease in plasma albumin levels for bleeding.
with age may result in decreased 4. DRUG-FOOD INTERACTION
binding of drugs that are mainly bound Ø the effect of a drug or food can be
to serum albumin influenced by their combined actions.
ü decrease in total body water, and • EX: Theophylline and caffeine-
intracellular water volumes may lead increased risk for potential toxicity.
to an increased serum concentration of • Levodopa and clonidine- decreased
water-soluble drugs such as lithium antiparkinsonian effect.
and alcohol 5. DRUG- DISEASE INTERACTIONS
Ø DRUG DISTRIBUTION Ø certain states may be exacerbated by
ü increase in body fat may increase in specific drug therapies, and these
the distribution of fat- soluble drugs may be contraindicated in
medications (e. g. benzodiazepines) patients with coexisting underlying
disease.
 • EX: Aspirin, NSAID’s and Atrophic likelihood of the accumulation of the
gastritis- GI hemorrhage patent drug and its active metabolite,
POLYPHARMACY thus increase toxicity.
Ø Prescription, administration, or use of • NOTE: DAILY USE OF BOTH SHORT-
more medications that are clinically AND LONG-TERM ACTING
indicated in given patient. BENZODIAZEPINES
Ø MULTIPLE MEDICATIONS INCREASE THE ü should be limited for less than 4
CHANCE OF: continuous months
1. drug-drug interaction ü should be limited unless an attempt at
2. ADE’s and ADR’s gradual dose reduction is unsuccessful
3. Error of dosing ü dose reduction should be considered
PREVENTION OF POLYPHARMACY after 4 months
1. Use of the same pharmacy to fill all ANTIDEPRESSANTS
prescriptions. Ø all antidepressant is generally equally
2. Notification to all prescribing clinicians effective and typically take effect in 2-
of drug used. 4 weeks
3. Nurse obtaining a complete history of Ø overall, tricyclic antidepressants
all drugs used. should be avoided in the older patient
FEDERAL LEGISLATIONS because of their anticholinergic and
1. Omnibus Budget Reconciliation sedative side effect
Act (OBRA) 1987 Ø newer SSRIs are often considered the
• legislated the appropriate use of first choice for antidepressants in older
medications in institutionalized older adults because of their lack of TCA side
persons. effects
a. use of chemical restraint ANTIPSYCHOTICS
b. use of unnecessary drugs Ø should be only when valid and clear
• Antipsychotic drugs should not be used documentation of need exist
unless necessary to treat a specific Ø appropriate indications for
condition that is diagnosed and antipsychotic prescription include
documented in the clinical record. schizophrenia, paranoid states, and
symptoms of psychosis such as
hallucinations and delusion
K.T.B 7 Ø 3D’s that may justify antipsychotic
use:
2. BEERS CRITERIA  Danger to the resident of others
• Commonly used consensus criteria r/t  Distress for the residents
inappropriate medications.  Dysfunction of the resident,
• Developed in 1997, and adopted in including interference with basic
1999 by the Centers for Medicare and nursing care
Medicaid Services for the regulations CONDITIONS INAPPROPRIATE FOR
of medications in nursing homes. ANTIPSYCHOTIC DRUGS
• Inappropriate medications • Wandering, Poor self-care,
administered to older person include: Restlessness
a. prescriptions for long-acting • Impaired memory, Anxiety, Depression
benzodiazepines, persantine, • Insomnia, Unsociability
propoxyphene • Indifference to surroundings
b. long-term use of drugs that are to be • Nervousness, Uncooperativeness
used for short-term use only (e.g., • Agitated behavior when not a danger
histamine blockers, short-acting to other self or others
benzodiazepines, oral antibiotics)
c. High doses of drugs prescribed above
dosage limitations (Fe supplements, CARE OF OLDER ADULTS NCMB
histamines blockers, antipsychotic
agents). RESIDENTS WHO USE ANTIPSYCHOTIC
COMMONLY USED MEDICATIONS DRUGS SHOULD RECEIVE:
• Anxiolytic and Hypnotics • GRADUAL DOSE REDUCTION
Ø anxiety can be significant problem in • DRUG HOLIDAYS-a patient stops taking
older persons and is often associated a medication(s) for a period of time.
with depression & dementia • BEHAVIORAL PROGRAMMING unless
Ø according to the Beer’s list, contraindicated
benzodiazepines with long half-lives PRN NEUROLEPTICS
should be avoided because of the
 § Are not to be used more than twice in ü Liver or renal function is
a 7-day period without further decreased.
assessment unless for the purpose of ü An individual experiences
titrating dosage for optimal response exaggerated responses to drug.
and for management of unexpected
behaviors otherwise unmanageable.
CARDIOVASCULAR MEDICATIONS
• * Older adults have an increased risk
for orthostatic hypotension and
dehydration, especially with volume-
depleting agents and vasodilators* K.T.B 8
ANTIMICROBIAL
• Dosing may need to be altered in older 3. One drug should not be used to treat
clients because of reduced renal the side effect of another drug.
elimination. ü Better to change the offending
NONPRESCRIPTION AGENTS drug.
ž FDA’s 3 MAIN CRITERIAS FOR ü Decrease the dosage in order to
SWITCHING PRESCRIBED MEDICATION decrease the side effects.
TO OTC STATUS: 4. ALTERNATIVES should be considered.
1. A record of established safety data for 5. START SLOW, go SLOW.
the prescription product is necessary. 6. TITRATE therapy.
2. The drug’s expected use should be 7. Educate the client.
appropriate for OTC treatment. 8. Review regularly.
3. The drug should lack undesirable MEASURES TO MANAGE MEDICATION
property and not require special CORRECTLY
precautions when used without ü Decreasing the number of pills to be
physician oversight. taken in a day.
NONADHERENCE (non-compliance) ü Establishing a routine for taking
RISK FACTORS medications.
• Living alone without social support. ü Preparing medications for the day in
• Visual or auditory impairments. different containers.
• Increasing use of alcohol. ü Developing memory methods.
• Socioeconomic factors. ü Scheduling in conjunction with other
• Unpalatable bulk powders or large daily activities.
tablets. ü Using reminders such as telephone or
NURSING MANAGEMENT FOR IMPROVING e-mail.
CLIENTS’ ADHERENCE ü Conduct a brown bag assessment.
Ø If knowledge deficits are a problem, ü Bring all medications including OTCs.
provide verbal education, reinforced ü Check:
with written instructions and allow  Outdated preparations
time for client’s feedback.  Unused or unfinished
Ø Encourage a client who “pharmacy prescriptions
shops” to have prescriptions filled at  Overlap or duplication of
the same pharmacy each time. medications
Ø Provide cues to assist remembering to
take medications.
Ø Reduce the impact of drug side effects. NURSING CARE OF THE OLDER
P Give adequate intake of fiber
and fluid to reduce constipation. ADULT IN CHRONIC ILLNESS
P Diuretics can be scheduled in Sensory Impairment
the morning to reduce  Visual
interruptions of activities and  Hearing
sleep.  Taste
P Use of Isotonic liquids or sugar-  Olfactory
free lozenges can help with dry 1. Visual
mouth. Cataracts
GENERAL PRESCRIBING PRINCIPLE • It’s an eye disorder that occurs when
1. Encourage the discontinuation of one the lens of the eye loses its
drug when another is added. transparency.
2. Consider reducing dosages when: • As a result, the transmission of light to
ü Weight is less than average. the retina is affected, which leads to
vision impairment. This impairment is
 described as cloudy, murky visual placed in the eye. This lens will stay in
perception. the eye permanently and is the eye’s
Causes of Cataracts: new lens.
Aging (senile cataracts) Health teaching after surgery:
• over time the lens starts to lose its • Position on non-surgical side.
transparency and proteins start to stick • Eye shield worn after surgery (per
together on the lens and over time the surgeon recommendations and when
lens becomes cloudy. removed wear glasses throughout the
Congenital day)
• born with a cataract • while sleeping or napping wear the eye
• example: mom had a rubella infection shield to protect the eye from rubbing
during 1st trimester or trauma
Trauma to the eye • Eye drops needed (antibiotics, anti-
Disease processes: diabetes (uncontrolled inflammatory)….use clean hands
diabetes) • Restricting activities that could
Unprotected eye exposure to sunlight increase eye pressure (heavy lifting,
Medications: corticosteroids running, coughing, bending,
Lifestyle: smokers, alcohol consumption, swimming)…can watch TV as desired.
family history • Pain should be minimal
Signs and Symptoms of Cataracts (Acetaminophen if needed
• Cloudy/blurry vision (can also have • NORMAL: itching (don’t rub) and
double vision in the affected eye) blurriness normal for few day
• Acquiring frequent eye glass • ABNORMAL: notify if severe pain or
prescriptions to help vision further decrease in vision, light flashes
• Toned-down colors (washed out and or floaters (could indicate retinal
faded) detachment), purulent drainage,
• Sensitivity to glare and light excessive redness, or fever
• Keep appointments, will check eye
healing (may need new glass
prescription once the healing process
is over)
• Lights seem too bright (glare) and Glaucoma
halos around lights (tends to be worst • No cure but there are treatments to
at night…many patients notice this help prevent damage to the optic
when they drive at night) nerve by lowering the IOP, hence
Tools Used to Diagnose Cataracts prevent blindness.
• Visual Acuity test with Snellen Chart • There are different types of glaucoma.
• Slit-lamp: helps enlarge the front areas We will talk about the two main types
of the eye to allow the doctor to see in this lecture called: open-angle and
the structures of the eye for evaluation angle-closure
like the cornea, lens, iris etc. • Most common type is called open-
• Dilation of the pupils to assess the angle, and the symptoms are very
optic nerve with an ophthalmoscope subtle with many people being
Cataracts Treatment unaware they have glaucoma until the
1. Monitoring the cataract until it disease has advanced.
progresses to a point where the patient • Angle-closure (also sometimes referred
cannot perform normal activities (first to as narrow-angle or closed-angle) is
option) rare but develops suddenly and
• Regular eye checkups and changing requires immediate intervention.
eyeglass prescriptions
• Anti-glare glasses K.T.B 9
• Education: Protecting eyes from sun
rays, magnifying items for better
views, and adding more light • Early detection is vital with
2. Surgery: remove the cloudy lens and glaucoma, which can be done with an
replace it with an intraocular lens (IOL) eye exam to monitor intraocular
• Phacoemulsification: type of pressure.
extracapsular extraction that is • A tonometer is used to measure the
performed to remove the cloudy lens intraocular pressure.
by breaking it up with sound waves. • A normal intraocular pressure is about
• The old lens is removed and a new 10-21 mmHg.
lens called an intraocular lens (IOL) is Types of Glaucoma
 • Vision lost already will not come
back…helps control pressure for
several years not permanent.
General post-op education points after
glaucoma surgery:
• Keep post-op appts. (very important
because eye pressure is monitored
Signs and Symptoms of Open-angle along with other important post-op
Glaucoma assessments)
• Silent: asymptomatic in early stages…
you may have heard it referred to as a
“thief of sight”
• It happens gradually and when the
patient notices the s/s the disease has • No driving until cleared by doctor.
advanced to permanent vision loss. • Protective sunglasses when in the
• No pain direct sunlight.
• Increased intraocular pressure (patient • Instill eye drops exactly as prescribed
needs to have various readings at (antibiotics/anti- inflammatory) and
different times) use clean hands.
• Loss of peripheral vision: this is side • Don’t rub eyes, use contact lenses,
vision (not really noticeable to the and avoid activities that increase eye
patient until they develop tunnel pressure: bending, straining activities
vision) like reading or straining during bowel
Signs and Symptoms of Angle-closure movement (may need stool softeners),
or lifting heavy objects
• Wear eye shield as prescribed
• Blurred vision, eyes tear up more
frequently, and eyes feeling itchy
(stitches) are normal after procedure
but will decrease overtime….report
any sudden vision loss or severe
pain….some pain is common
• Monitor for signs of infection:
discharge, fever, extreme eye redness
glaucoma: and vision changes
Nursing Interventions Open Angle • Immediate treatment for angle-closure
Glaucoma glaucoma (emergency): remember this
• Treatment goal is to reduce type is NOT silent with its symptoms
intraocular eye pressure to prevent (patient will report symptoms as noted
damage to the optic nerve above)
• Medication first-line treatment (eye • Mediations: eye drops and oral
drops or oral meds) if don’t work may medication to drop eye pressure along
need with
• Surgical (laser procedure or general • Surgical procedure:
traditional eye surgery)  laser iridotomy: small hole
• Selective Laser Trabeculoplasty created in the iris with a laser to
(SLT): quick procedure that is drain the increased aqueous
completed in minutes. It lowers IOP by humor
using lasers to target certain parts of  Iridectomy: removes part of
the drainage angle tissue which causes the iris) may be performed in
changes to the tissue, and these tissue both eyes because of the risk of
changes allow extra fluid to drain out the other eye developing angle-
of the eye. IOP will be lowered over a closure as well.
couple of months. Age-Related Macular Degeneration
• Not permanent treatment…results last • Macular degeneration is largely an
for several years. age-related disease process whereby
• Trabeculectomy (one common type): central vision gradually deteriorates.
decreases IOP pressure in the eyes Risk Factors
(used when eye drops or other • Increasing age
procedures are not working) • Smoking history
• Hypertension
• Overweight
 • Hyperopia • Eye floaters and spots
• Familial incidence • Double vision
• Wet AMD (more common in Caucasians • Eye pain
than African Americans) Treatments
• Arthritis Medical control
Assessment/Clinical • Controlling your blood sugar and blood
Manifestations/Signs and Symptoms pressure can stop vision loss.
• Blurred vision • Carefully follow the diet your
• Blind spot in the middle of the visual nutritionist has recommended. Take
field the medicine your diabetes doctor
• Central vision can also be lost as small prescribed for you. Sometimes, good
blind spot may also begin to develop sugar control can even bring some of
Nursing Management your vision back. Controlling your
• Nursing management is primarily blood pressure keeps your eye’s blood
educational. vessels healthy.
• Manage your other medical conditions. For Laser surgery
example, if you have cardiovascular • Laser surgery might be used to help
disease or high blood pressure, take your seal off leaking blood vessels. This can
medication and follow your doctor's reduce swelling of the retina. Laser
instructions for controlling the condition. surgery can also help shrink blood
• Don't smoke. Smokers are more likely to vessels and prevent them from
develop macular degeneration than are growing again. Sometimes more than
nonsmokers. Ask your doctor for help to one treatment is needed.
stop smoking. Nursing Management
• Maintain a healthy weight and exercise Health Education
regularly. If you need to lose weight, • Manage your diabetes.
reduce the number of calories you eat and • Monitor your blood sugar level.
increase the amount of exercise you get • Ask your doctor about a glycosylated
each day. hemoglobin test.
• Keep your blood pressure and
cholesterol under control.
• If you smoke or use other types of
K.T.B 10 tobacco, QUIT or ask your doctor to
help you quit.
• Choose a diet rich in fruits and • Pay attention to vision changes.
vegetables. Choose a healthy diet that's 2. Hearing loss
full of a variety of fruits and vegetables. • 30% aged 65 to 76 years
These foods contain antioxidant vitamins • 50% >75 years
that reduce your risk of developing • Older men > older women
macular degeneration. • Caucasian men and women > African
American men and women
• Temporary threshold shift (TTS)
• Include fish in your diet. Omega-3 fatty • Sounds < 75 dB(A) → temporary
acids, which are found in fish, may hearing loss
reduce the risk of macular • Sounds > 85 dB(A) for 8hrs/day +
degeneration. Nuts, such as walnuts, many years → permanent loss
also contain omega-3 fatty acids.
Diabetes Retinopathy
• A diabetes complication that
affects the eyes. It's caused by
damage to the blood vessels of the
light-sensitive tissue at the back of the
eye (retina). Signs of Hearing Loss
• At first, diabetic retinopathy might • Have trouble hearing over the
cause no symptoms or only mild vision telephone
problems. • Find it hard to follow conversations
Symptoms when two or more people are talking
Symptoms might only be identified once the • Often ask people to repeat what they
disease advances, but the typical symptoms are saying
of retinopathy to look out for include: • Need to turn up the TV volume so loud
• Sudden changes in vision / blurred that others complain
vision
 • Have a problem hearing because of o Environmental exposure
background noise o Medical conditions
• Think that others seem to mumble
• Can’t understand when women and
children speak to you K.T.B 11
Risk Factors of Hearing Loss
• Loud noise • Oral status can affect gustatory
• Earwax or fluid buildup function
• A punctured eardrum. • Poor dentition → improper chewing →
• Health conditions less flavor release
• “Ototoxic” medications • Improperly fitting dentures →
• Smoking obstruction of palate → decreased
• History of middle ear infection taste perception
• Chemical exposure (e.g., long duration • Oral infections → release of acidic
of exposure to substances → altered taste + impaired
• trichloroethylene salivary stimulations → decreased
• Heredity ability for food to dissolve →
Tools Used to Diagnose Hearing Loss diminished flavor
• Whisper test • Focused assessment for taste
• Weber tests disturbances
• Rinne tuning fork test  Head and neck
Types of Hearing Loss  Mucous membranes
• Hearing loss comes in many forms. It  Interview with focus on past
can range from a mild loss, in which a dietary habits
person misses certain high-pitched • Education
sounds, such as the voices of women  Implications of inability to
and children, to a total loss of hearing. distinguished between salt and
• There are two general categories of sugar
hearing loss:  Decreased taste → lack of
 Sensorineural hearing loss motivation to prepare + eat →
occurs when there is damage to malnutrition
the inner ear or the auditory 4. Olfactory Dysfunction
nerve. This type of hearing loss • Statistics
is usually permanent.  Males > females
 Conductive hearing loss • Causes
occurs when sound waves  Nasal and sinus disease
cannot reach the inner ear. The  Upper respiratory infection
cause may be earwax buildup,  Head trauma
fluid, or a punctured eardrum.  Secondary
Medical treatment or surgery  Chemotherapy or other
can usually restore conductive medications
hearing loss.  Radiation
Hearing Loss Assessment  Current or past use of
• History cocaine or tobacco
• Physical examination  Poor dentition
o Inspection • Special concerns
o Examination of ear canal  Safety related to smoke and fire
o Childhood ear infections →  Malnourishment
ruptured eardrum → jagged • Sense of smell fails to be detected
white scars on tympanic because it is not adequately tested
membrane in elderly  Use three familiar smells
• Hearing Handicap Inventory for the  Repeat with both nostrils, in
Elderly (HHIE-S) different orders
• Talk with family members • Nursing diagnoses associated with
3. Taste hyposmia
• Contributing factors to taste  Sensory/perceptual alterations:
alterations olfactory
o Oral condition Nursing Assessment
o Olfactory function • Assess safety and preventive
o Medications measures
o Diseases • Additional assessment
o Surgical interventions  Nutrition
  Patient safety managing symptoms, promoting
• Date and label all foods independence, and ensuring safety.
• Place natural gas detectors in the • Assessment and Diagnosis
home (for gas heat) • Person-Centered Care
• Place smoke detectors in strategic • Behavioral Management
locations • Medication Management
• Establish schedules for personal • Communication Techniques
hygiene and house cleaning • Cognitive Stimulation
• Remove kitchen waste every evening • Promotion of Independence
Learning Objective: Recognize nursing • Nutrition and Hydration
interventions that can be implemented to • Family and Caregiver Support
assist the aging patient with sensory • Regular Monitoring
changes. • End-of-Life Care
Dementia
Assessment for Dementia
• Patient History
• Physical Exam
• Neurological Tests

Types of Dementia
Alzheimer Disease
• Most common dementia diagnosis
among older adults.
• It is caused by changes in the brain,
including abnormal buildups of
proteins known as amyloid plaques
and tau tangles.
Vascular Dementia K.T.B 12
• A form of dementia caused by
conditions that damage blood vessels ACUTE CONFUSIONAL STATE
in the brain or interrupt the flow of • An acute confusional state (delirium) is
blood and oxygen to the brain. an acute disturbance of brain function.
Lewy Body Dementia
• A form of dementia caused by
abnormal deposits of the protein
alpha-synuclein, called Lewy bodies.
Parkinson’s Disease Dementia
• People with the nervous system
disorder Parkinson's disease get this
type of dementia about 50% to 80% of
the time.
• This type is very similar to DLB.
Frontotemporal Dementia
• less common but distinct form of
dementia that primarily affects the
frontal and temporal lobes of the brain. Nursing Interventions for Delirium
• starts with changes in personality, • Assessment and Identification
behavior, and language abilities. • Environmental Modification:
Mixed Dementia • Orientation and Reorientation:
• This is a combination of two types of • Medication Management:
dementia. • Hydration and Nutrition:
• The most common combination is • Supportive Communication:
Alzheimer's disease and vascular • Behavioral Management:
dementia. • Regular Monitoring:
Nursing Intervention for Dementia • Medication for Symptom Management:
The goals of these interventions include • Family and Caregiver Education:
enhancing the person's quality of life, Communicating with the elderly with
impaired verbal communication?
Ø Use proper form of address. Establish
respect right away by using formal
language. ...
Ø Make older patients comfortable. ...
Ø Take a few moments to establish
rapport. ...
Ø Try not to rush. ...
Ø Avoid interrupting. ...
Ø Use active listening skills. ...
Ø Demonstrate empathy. ...
Ø Avoid medical jargon.