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Medical-Surgical Nursing: An Integrated Approach, 2E Chapter 35


Medical-Surgical Nursing: An Integrated Approach, 2E Chapter 35 NURSING CARE AND THE OLDER CLIENT Gerontology The study of the effects of normal aging and age-related ... – PowerPoint PPT presentation

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Title: Medical-Surgical Nursing: An Integrated Approach, 2E Chapter 35

Medical-Surgical Nursing An Integrated Approach,
2E Chapter 35

  • The study of the effects of normal aging and
    age-related diseases on human beings.

Demographic Profile of Older Adult Population
  • Clinical delineation is 65 years of age or older.
  • Older-old adults are 85 or older.
  • By the year 2030, the number of older adults in
    the United States will reach 70.2 million.

Characteristics of the Older Adult Population
  • Rapidly growing.
  • Although many stereotypes and myths are
    associated with aging, elders are in fact very
    diverse in their characteristics.

Stereotyping Older Adults
  • Health professionals must be diligent in avoiding
    age prejudice, as believing stereotypes can
    influence interactions between older adults and

Major Theories of Aging Biological
  • Somatic Mutation Theory (Changes associated with
    aging are the result of decreased function and
    efficiency of cells and organs)
  • Programmed Aging Theory (Genetic clock determines
    speed of aging)
  • Cross-linkage, or Collagen, Theory (Loss of
    flexibility results in diminished functional
  • Immunity Theory (Diminishing of thymus results in
    impaired immunologic function)
  • Stress Theory (Stress causes structural and
    chemical changes that eventually result in
    irreversible tissue damage).

Major Theories of Aging Psychosocial
  • Activity Theory (Life satisfaction depends on
    maintaining an involvement with life by
    developing new interests, hobbies, roles, and
  • Disengagement Theory (Decreased interaction
    between older person and others in the social
    system is inevitable, mutual, and acceptable to
    both the individual and society).
  • Continuity Theory (Successful methods used
    throughout life for adapting and adjusting to
    life events are repeated. Traits, habits, values,
    associations, and goals remain stable, regardless
    of life changes).

Myths about Aging
  • Senility is a result of aging.
  • Incontinence is a result of aging.
  • Older adults are no longer interested in
  • Most people spend their last years in nursing
  • All elderly persons are financially impoverished.

Realities of Aging
  • Dementia is disease-related, not age-related.
  • Incontinence is not present among all aged.
  • Sexuality is a lifelong need.
  • 10 to 40 of elderly in the U.S. may spend some
    time in extended care facilities.

Activities of Daily Living
  • Basic care activities that include
  • Mobility.
  • Bathing.
  • Hygiene.
  • Grooming.
  • Dressing.
  • Eating.
  • Toileting.

Exercise and the Older Adult
  • Research indicates that high-intensity,
    progressive resistance training can improve
    muscle strength and muscle size in frail elderly
  • Exercise programs should be individually planned
    and should take into account the clients general
    health status, physiologic disorders (if
    present), physical environment, and other factors.

Nutrition and the Older Adult
  • Elders must follow a balanced diet, often with
    lowered intakes of sugar, caffeine, and sodium.
  • There are no universally accept dietary
    guidelines specific to older adults.
  • It is important that nurses be knowledgeable
    about community services designed to help older
    clients meet their nutritional needs.

Strengths of Older Adults
  • Physiologic changes may result in losses, causing
    impairments in communication, vision and
    learning, mobility, cognition, or psychosocial
  • The strengths of each individual (including past
    coping skills) must be identified and utilized
    when planning care.

Health Promotion and Disease Prevention
  • Older adults must be alerted to means of
    preventing disease and reducing risks.
  • Being knowledgeable about self-care and
    participating in screening tests are important
    components of health maintenance.

  • The problem of clients taking numerous
    prescription and over-the-counter medications for
    the same or various disease processes, with
    unknown consequences from the resulting
    combination of chemical compounds and cumulative
    side effects.

Physiologic Changes Associated with Aging
  • Respiratory System
  • Cardiovascular System
  • Gastrointestinal System
  • Reproductive System Female
  • Reproductive System Male
  • Endocrine System
  • Musculoskeletal System
  • Integumentary System
  • Nervous System
  • Urinary System
  • Sensory Changes

Respiratory System Changes
  • Muscles of respiration become less flexible.
  • Decrease in functional capacity results in
    dyspnea on exertion or stress.
  • Effectiveness of cough mechanism lessens,
    increasing risk of lung infection.
  • Alveoli thicken and decrease in number and size.
  • Structural changes in the skeleton can decrease
    diaphragmatic expansion.

Cardiovascular System Changes
  • Cardiac output and recovery time decline. The
    heart requires more time to return to normal rate
    after a rate increase in response to activity.
  • Heart rate slows.
  • Blood flow to all organs decreases.
  • Arterial elasticity decreases, causing increased
    rise in blood pressure.
  • Veins dilate and superficial vessels become more

Gastrointestinal System Changes
  • Tooth enamel thins.
  • Periodontal disease rate increases.
  • Taste buds decrease in number, and saliva
    production diminishes.
  • Effectiveness of the gag reflex lessens,
    resulting in increased risk of choking.
  • Arterial elasticity decreases, causing increased
    rise in blood pressure.
  • Veins dilate and superficial vessels become more

Reproductive System Female Changes
  • Supporting musculature of the reproductive organs
    weakens, increasing risk of uterine prolapse.
  • Breast tissue diminishes.
  • Libido and the need for intimacy and
    companionship in older women remains unchanged.
  • Estrogen production decreases with onset of
  • Ovaries, uterus, and cervix decrease in size.
  • Vagina shortens, narrows, becomes less elastic
    vaginal lining thins.

Reproductive System Male Changes
  • Testosterone production decreases, resulting in
    decreased size of testicles.
  • Impotency may occur.
  • Although more time is require to obtain erection,
    the older man often finds hat he and his partner
    can enjoy longer periods of lovemaking prior to
  • Prostate gland may enlarge.
  • Libido and need for intimacy and companionship
    remain unchanged in older males.
  • Sperm count and viscosity of seminal fluid

Endocrine System Changes
  • Alterations occur in both the reception and the
    production of hormones.
  • Release of insulin by the beta cells of the
    pancreas slows, causing an increase in blood
  • Thyroid changes may lower the basal metabolic

Musculoskeletal System Changes
  • Muscle mass and elasticity diminish, resulting in
    decreased strength, endurance, coordination, and
    increased reaction time.
  • Bone demineralization occurs, causing skeletal
    instability and shrinking of intervertebral
  • Joints undergo degenerative changes, resulting in
    stiffness, pain, and loss of range of motion.

Integumentary System Changes (i)
  • Subcutaneous tissue and elastin fibers diminish,
    causing skin to become thinner and less elastic.
  • Hyperpigmentation or liver spots.
  • Diminished secretions and moisturization.
  • Body temperature regulation diminishes.
  • Capillary blood flow decreases, resulting in
    slower wound healing.
  • Blood flow decreases, especially to lower

Integumentary System Changes (ii)
  • Vascular fragility causes senile purpura.
  • Cutaneous sensitivity to pressure and temperature
  • Melanin production decreases, causing gray-white
  • Scalp, pubic, and axillary hair tin, and women
    display increased facial hair.
  • Nail growth slows, nails become more brittle, and
    longitudinal nail ridges form.

Nervous System Changes
  • Neurons in the brain decrease in number.
  • Cerebral blood flow and oxygen utilization
  • Time required to carry out motor and sensory
    tasks requiring speed, coordination, balance, and
    fine-motor hand movements increases.
  • Short-term memory may somewhat diminish without
    much change in long-term memory.
  • Night sleep disturbances occur due to more
    frequent and longer wakeful periods.
  • Deep-tendon reflexes decrease, although reflexes
    at the knees remain fairly intact.

  • An organic brain pathology characterized by
    losses in intellectual functioning.
  • The clinical manifestations associated with
    dementia are never considered normal aging

Urinary System Changes
  • Nephrons in the kidneys decrease in number and
  • Glomerular filtration decreases.
  • Blood urea nitrogen increases.
  • Sodium-conserving ability diminishes.
  • Bladder capacity decreases.
  • Renal function increases when the older client
    lies down.
  • Bladder and perineal muscles weaken.
  • Incidence of stress incontinence increases in
    older females.
  • Prostate may enlarge in older males, causing
    urinary frequency and dribbling.

Sensory Changes Vision
  • The lens becomes less pliable and less able to
    increase its curvature in order to focus on near
  • Accommodation of pupil size decreases, resulting
    in both decreased adjustment to changes in
    lighting and decreased ability to tolerate glare.
  • Vitreous humor changes in consistency, causing
    blurred vision.
  • Lacrimal glands secrete less fluids, causing
    dryness and itching.
  • Lens yellows, causing distorted color perception.

Sensory Changes Hearing
  • The pinna becomes less flexible, hair cells in
    inner ear stiffen and atrophy, and cerumen
    (earwax) increases.
  • Number of neutrons in the cochlea decrease and
    blood supply lessens, causing degeneration.
  • Presbycusis, the impairment of hearing in older
    adults, is often accompanied by a loss of tone

Financing Elder Care in the 21st Century
  • Medicare
  • Medicaid
  • Omnibus Budget Reconciliation Act
  • Balanced Budget Act of 1997