Issues in Gerontological Nursing

1
Issues in Gerontological Nursing
Content for this module provided from The John A.
Hartford Foundation, Institute for Geriatric
Nursing, Online Gerontological Nursing
Certification Review Course http//www.nyu.edu/edu
cation/nursing/hartford.institute/course/
Support for this project provided to School of
Nursing, University of Washington by the John A.
Hartford Foundation, Geriatric Nursing Education
Grant and Nursing School Geriatric Investment
Program Grant.
2
Issues inGerontological Nursing

• Overview
• Normal age-related changes
• Functional implications
• Nursing considerations

3
Issues inGerontological Nursing

• Attitudes?
• Perceptions?

4
Normal Age-Related Changes

• Biological aging universal , progressive,
  intrinsic
• ? ability to maintain homeostasis
• ? response to physical and emotional stresses
• ? reserve capacity
• Multiple system changes - triggering effect
• The older we get, the more different we are
  baseline patterns are important!

5
Normal Age-Related Changes
Genetics (non-modifiable)
Lifestyle Environment (modifiable)
Reserve Capacity
6
Normal Age-Related Changes

• ? reserve capacity due to passage of time
• ? exposure to disease - causing factors
• ? ability of body to maintain normal ranges
• ? susceptibility, ? incidence to disease
• Aging DOES NOT automatically include disease

7
Changes Associated With Aging
Normal age-related
Abnormal
vs
8
Abnormal Changes

• May accompany or AMPLIFY normal age-related
  changes
• Disease
• Cardiovascular
• Abuse, misuse
• Sunlight exposure - skin
• Loud noise - hearing
• Repeated traumatic injury (athletes) - joints
• Disuse
• Inadequate exercise - cardiac, muscle, bone

9
Functional Decline
Genetics (non-modifiable)
Lifestyle Environment (modifiable)
Reserve Capacity
Functional Decline

Illness

10
Normal vs Abnormal Why Differentiate?

• Prevention
• Early detection
• Proper intervention
• Proper evaluation of treatment effects
• Dont assume symptom is caused by aging

11
Normal CardiovascularChanges

• ? heart rate
• Left ventricular wall thickens
• ? collagen, ? elastin in heart muscle
• Valves become stiffer, thicker
• Atherosclerosis

? myocardial muscle contraction ? cardiac
output cardiac reserve
12
Normal Cardiovascular Changes

• Functional Implications

• Fatigue and activity tolerance
• Orthostatic hypotension
• Dizziness w/position changes
• Hypertension risk for stroke
• Influenced by presence of disease (both
  cardiovascular and/or non-cardiovascular)
  lifestyle variations

13
Normal Respiratory Changes

• ? breathing effort under stress
• ? breathing efficiency
• ? respiratory rates
• ? ability to clear secretions, ? susceptibility
  to infections, ? risk of aspiration
• Muscle de - conditioning

14
Normal GastrointestinalChanges

• No clear - cut GI diseases attributed directly to
  the aging process
• GI-related symptoms should not be dismissed as
  part of the normal aging process

15
Normal GastrointestinalChanges

• Pharmacological considerations
• ? digestion and ? absorption
• Primary, secondary prevention of GI tract
  problems

16
Normal GastrointestinalChanges

• Common symptoms associated with age-related
  changes to stomach, esophagus, small large
  intestines
• Fullness, dysphagia, heartburn, vomiting, sternal
  pain (be sure to differentiate from CV problem!)
• Decreased appetite
• Constipation
• Decreased saliva production

17
Normal Hepatic Changes

• ? blood flow to the liver
• In absence of disease, liver function is
  maintained
• 5-30 ? drug clearance
• ? drug use / polypharmacy, ? age can lead to drug
  induced liver disorders

18
Normal Renal Changes

• ? blood flow and glomerular filtration rate (GFR)
• Adequate function into 90s unless acute illness
  and/or comorbidities exist
• ? adaptive responses watch F E w/acute
  illness
• Medications excreted by kidneys - dosing

19
Normal Urinary Changes

• ? bladder capacity
• ? urine production at night (nocturia)
• Thinning of urethral mucosa r/t ? estrogen
• ? urethral resistance r/t ? muscle tone bulk
• ? bladder emptying r/t enlarged prostate (not
  considered normal but high prevalence among older
  men)

20
Normal Urinary Changes

• Urinary incontinence IS NOT a normal age-related
  change
• Prevalence of urinary incontinence
• 1 in 3 older adults living in the community
• Normal age-related changes, PLUS
• Drug side - effects
• UTIs
• Conditions impairing mobility

21
Normal Sexuality Reproduction Changes

• Men ? testosterone
• Women ? estrogen, progesterone, androgen
• Continued interest in sexual activities
• ? sexual activity is more situational
• Drug side effects, chronic/acute illness
• Functional changes
• ? ovarian function sperm production
• Performance changes
• Dysfunction is NOT normal part of aging

22
Normal Integumentary Changes

• ? thickness, elasticity, vascularity strength
• Increased risk of skin tears bruising
• Delayed healing process
• ? sebaceous sweat gland activity
• ? thermoregulation sweating
• ? incidence benign malignant skin growths

23
Normal Neurological Changes

• ? neural transmission time
• ? of neurons and nerve fibers
• ? muscle coordination speed
• ? reaction time
• ? sleep stages II IV, thus ? nighttime
  awakenings
• ? hypothalamus regulation of temperature
• ? risk of heatstroke hypothemia
• Cognitive impairment is NOT a normal age-related
  change

24
Normal Immune System Changes

• ? physical barriers
• changes in skin mucous membranes
• ? cellular (T-cell mediated) immunity
• atrophy of thymus affects T cell s function
• ? humoral (B-cell mediated) immunity
• ? production of immunoglobulins
• ? production of autoantibodies

25
Normal Immune System Changes

• Overall ? ability to provide protection
  ? immunocompetence
• ? infections
• ? cancer
• ? autoimmune process

26
Normal Sensory Changes

• Eyes
• ? visual acuity (especially near vision)
  narrowing of visual field
• ? adaptation to light changes
• Presbyopia (? ability to focus)
• Color vision impairment

27
Normal Sensory Changes

• Ears balance
• ? tone discrimination
• Difficulty hearing high frequency sounds
• Presbycusis ( ? hearing acuity)
• ? ability to discern consonants
• ? equilibrium r/t vestibular changes

28
Normal Musculoskeletal Changes

• Bones
• ? mineral content
• ? mass
• Collagen formation
• gt viscous synovial fluid
• gt fibrotic synovial membranes
• ? joint cartilage
• ? water content elasticity of cartilage

29
Normal Musculoskeletal Changes

• Muscles
• ? mass
• ? tendon size - sclerosis
• ? elasticity of ligaments tendons

30
Normal Musculoskeletal Changes

• ? flexion/extension of spine

Posture gait changes
31
Normal Age-Related Changes
? mobility
Joint stiffness ? muscle strength
Pain
Disability, loss of independence, frailty, falls
32
Falls

• ? mobility
• Cognitive changes
• MSK-related posture gait changes
• Neuro-related gait proprioception changes
• Environmental hazards

? Bone weakness
? fall risk
Fractures
33
Hip Fractures

• Leading cause of disability among older adults
• Most common site of fracture is the neck of the
  femur
• Occur more frequently in women than men

34
Hip Fractures

• Treatment goals
• Function and motion restored
• Complications minimized
• Treatment procedures
• Surgery - most common
• Skin traction - preoperatively to ? muscle spasms
• Common complications include
• Pneumonia, venous thrombosis, pressure ulcers,
  and elimination dysfunction

35
Hip Fractures

• Nursing interventions
• Neurovascular assessment - mobility, circulation,
  sensation, edema
• Pain management, wound care
• Prevent thromboembolism - antiembolism stockings/
  anticoagulant therapy
• Avoid forcing hip flexion greater than 90 degrees
• Avoid forcing adduction, internal rotation, or
  crossing of legs
• Monitor for delirium (a common complication)

36
Caring for the Older Adult

• Think
• What is baseline? What is nature of the
  change?
• Is what I am seeing a normal change or disease
  process?
• What else is going on? (meds, other systems,
  environment, psychosocial)