Geri 1 Flashcards
(81 cards)
1
Q
chronological age
A
Length of time since birth
2
Q
perceived age
A
People’s estimation of someone’s age
3
Q
subjective age
A
Person’s perception of their age
4
Q
Functional age
A
Reflects cumulative effect of medical & psychosocial stressors on the ageing process
5
Q
Ageism
A
Stereotypes or generalizations (usually negative) applied to older adults grounded on the basis of age
6
Q
Aging anxiety
A
Fears and worries regarding detrimental effects associated with aging
7
Q
Age attribution
A
Tendency to automatically attribute problems to aging process instead of pathologic treatable conditions
8
Q
Myths
A
- By 75 yrs, people are quite homogeneous as a group
- Families no longer care for older people
- By age 70 yrs, psychological growth is complete
- Increased disability is due to age-related changes.
- Most older adults are constipated primarily due to age-related changes
9
Q
Realities
A
- Older adults are diverse with different values and lifestyles just like young people
- In the US, 80% of older adults’ care is provided by their families
- Some brain functions decline but others continue to develop
- Many problems attributed to old age are pathological and respond to treatment
- Constipation is prevalent among older adults primarily due to risk factors and pathological changes
10
Q
Demographics
A
- Average life expectancy: 78
- Older adults are projected to outnumber children by 2035
- increase in the proportion of older adults who are members of minority groups
- gradual increase in overall life expectancy
- women live longer
- Men who are alive are more likely to be married
11
Q
Change in Cultural Groups
A
- ↑ racial/ethnic diversity
- ↑ proportion of foreign born older adults (14% of older adults are foreign born)
12
Q
African Americans
A
- Heterogeneous, have a wide range of socioeconomic conditions
- Less likely to live alone, may have multi-generational household
- Consequences of racism are
still present and linked to health disparities - Factors contributing to poor health outcomes include discrimination, cultural barriers, and lack of access to health care
- Suspicion of health care providers linked to history of disparities
- Trusted leaders/providers in community provides pathway to care—sometimes associated with religious institutions
13
Q
Asian Americans
A
- Strong value on care of older family members
- Less likely to use nursing homes
- More accepting of mental decline in older adult
- Health is physical and spiritual harmony
14
Q
Hispanic/ Latino
A
- Diverse group
- Strong cultural respect for family and for older people
- Older adults frequently live with family members
- Health is a gift or reward given as G-d’s blessing
- Most in US speak both Spanish and English
15
Q
Native American/ Alaska Native
A
- Value older members of the community, particularly with regard to their roles as grandparents and story tellers
- Strong traditions related to spirituality and religious practices, with each tribe having unique expressions
- Belief in the connection among body, mind, and spirit
- High rates of all of the following conditions: diabetes, tuberculosis, heart disease, substance abuse, and certain cancers (e.g., liver, cervix, kidney, gallbladder, and colorectal
- Poorer health associated with low economic conditions, cultural barriers, access to care, and mistrust of health providers
16
Q
Cultural competence
A
Healthcare providers must recognize, respect and integrate clients’ cultural beliefs & practices into nursing care plans
17
Q
Cultural Self Assessment tool
A
An awareness-raising tool for gaining insight into the health-related values, beliefs, attitudes, and practices that have shaped and informed the person the nurse has become when providing care
18
Q
Cultural Humility
A
Entering a relationship with intention of honoring their beliefs, customs, and values
-self-evaluation
-sensitivity and openness
-address power imbalance
-avoid stereotyping
19
Q
Health Disparities
A
measurable differences that are expected/common but not preventable.
20
Q
Health Inequity
A
health outcome differences that are unfair, avoidable, and systemic
21
Q
Health Equity
A
all people have equal access to highest level of care
22
Q
Health Literacy
A
low is associated with:
decreased use of services
shorter life expectancy
multiple chronic diseases
decreased adherence
poor access to health care
lower levels of self-reported functional status
decreased ability to self-mange
increased hospitalizations
23
Q
Linguistic Competence
A
awareness of patients linguistic needs with differing primary language or dementia or sensory impairments
use interpreter not family or app
24
Q
Social Determinants of Health
A
Conditions that strongly influence life expectancy, health, functional status, QOL, and susceptibility to disease and disability
Include:
-Economic stability
-Education access and quality
-Health care access and quality
-Food insecurity
-Unemployment and job security
-Housing
-Neighborhood and built environment.
-Social support
25
Strategies to limit bias
cultural self-assessment
use resources to learn more about cultural groups that you frequently care for
ethno-geriatrics: integrates influence of race, ethnicity and culture on wellness of older adults
avoid stereotyping
obtain culturally specific information
26
Healthy Aging
no illness, and preserved functions
27
Active aging
high physical and cognitive function
28
Productive aging
social participation & engagement
29
Effective aging
the capacity to manage age related life challenges
30
Successful aging
full concept of aging well
31
Compression of Morbidity
if onset of chronic illness can be delayed, when life expectancy cannot QOL will be better
functional decline compressed into 3-5 years instead of 20
32
Biologic Theories of Aging
-Wear and Tear: human machine declined over time. Longevity determined by genetics and care provided.
-Free radical theory: organism age due to oxidative damage that can be fixed with antioxidants.
-Immunosenescence theory: decline in immune system that heightens susceptibility and leads to autoimmune conditions.
-Program theory: predetermined by genetics.
-Caloric restation theory: 30-40% reduction of caloric intake without malnutrition will increase lifespan in animals.
33
Biological Theories of Aging conclusions
- Biologic aging is viewed as inevitable, irreversible & progressive
- The course of aging differ from person to person
- Increase susceptibility to diseases and processes differ from pathologic processes
- Suggested variability in aging: ¼ genetics, ¼ early life environment, ½ life circumstances in adult life
34
Biological Theories of Aging Nursing Implications
provides important data on:
- How cells age and what triggers the aging process?
- Risk factors that aggravate age-related changes
35
Sociocultural Theories of Aging
-Activity Theory: people remain socially and psychologically fit if they are actively engaged in life.
-Subculture theory: old people interact more among themselves, and status is based on health and morbidity.
-Age stratification Theory: interactions between age and social structure and the aging of people in cohorts as social process
-Person-environment/ Ecological theory: older people with function limitation need to adapt to remain independent.
36
Sociocultural Theories of Aging Conclusions
- View older adults in relation to society and environments
- A better understanding of influences (culture, family, education, community, ascribed roles, cohort effects, home & living settings, personal & political economics)
- Emphasizes the importance of assessing environmental factors that influence the functioning of an older person
37
Sociocultural Theories of Aging Nursing Implications
Helps nurses view older adults in relation to society and cultural environment
38
Psychological Theories of Aging and Conclusions
-Erikson's life stages
- Nurses can use psychological theories to address response to losses, continued emotional development
- Maslow's hierarchy of needs framework is useful for conceptualizing the nature of interventions in institutional or home settings
- Devoting time and energy to life review and self-understanding can be beneficial for older adults
- Nurses can facilitate this process by asking sensitive questions and by listening attentively to older adults as they share information about their past
39
Psychological Theories of Aging Nursing Implication
addresses psychological factors pertinent to aging such as coping with loss
40
Concepts Underlying Functional Consequences Theory (FCT)
- Age-related changes & risk factors increase vulnerability to negative functional consequences
- Nurses assess age-related changes, risk factors, and functional consequences
- Goal: to identify factors that can be addressed through nursing interventions
- Wellness outcomes enable functioning at the highest level despite presence of age-related changes & risk factors
41
ADLs
Basic activities that allow a patient to care for themselves
42
IADLs
Complex activities that are important to getting a patient back to their life (e.g managing meds, balancing a checkbook)
43
Physical Changes with Healthy Aging
Key Concepts
- Physiological reserve: inherent ability to maintain homeostasis amidst external stressors
- Resilience: ability to recover quickly from illness
- Atypical presentation of illness: vague presentation, altered presentation or non-presentation of illness
44
Age Related Changes
Vitals
- Lower body temp
- Reduction in fever response
- Decreased ability to respond to stress
- Increases risk for pulmonary infection
- Increased risk for hypotension
45
Age Related Changes
Appearance
- Risk for skin tears increases
- Wound healing takes longer
46
Age Related Changes
Head and Sensory
- Presbyopia: decreased ability of eye to focus
- Presbycusis: hearing loss
- Diminished salivary secretions and decreased sense of taste occurs
47
Age Related Changes
Respiratory
-Diminished pulmonary reserve
-fatigue with stressors
-↑risk of infection
48
Age Related Changes
Cardiac
- ↓Exercise tolerance
- Fatigue, SOB with exercise
- Slower recovery from tachycardia
- Intolerance of volume depletion
49
Age Related Changes
GU
- Decreased creatinine clearance 🡪 risk of drug toxicity
- BPH
- Urinary urgency & frequency
- Weak stream/ Dribbling post urination: post micturition
- Incomplete bladder emptying
50
Age Related Changes
Musculoskeletal and Neuro
- Bone loss
- Loss of ROM
- Neurologic changes affect gait and balance
51
Age Related Changes
GI
- Delayed emptying of stomach contents and early satiety
- Dysphagia
- Constipation
52
Orthostatic Hypotension
A drop in SBP by ≥20 mmHg or DBP by ≥ 10 mmHg within 3 mins of standing from a supine or sitting position
53
Postprandial Hypotension
Systolic blood pressure drop of 20 mm Hg in a supine/sitting position within 120 minutes after eating a meal
54
Age Related Changes
Hearing: External Ear
Change
- Longer, thicker hair
- Thinner, drier skin
- Increased keratin
Consequence
- Impacted cerumen & impaired sound conduction
55
Age Related Changes
Hearing: Middle Ear
Change
- Diminished ear drum resiliency
- Calcified, hardened ossicles
- Stiff muscles & ligaments
Consequence
- Impaired sound conduction
56
Age Related Changes
Hearing: Inner Ear and Nervous System
Change
- Decreased: blood supply, endolymph, hair cells of the organ of corti, & neurons
- Degeneration of spiral ganglion
- ↓ flexibility of basilar membrane
- Degeneration of central processing systems
Consequence
- Presbycusis: diminished ability to hear high-pitched sounds, especially in the presence of background noise
57
Age Related Changes
Vision
- Age-related changes cause mild visual impairments which are significantly exacerbated by environmental conditions
- Loss of accommodation (presbyopia)
- Diminished acuity
- Delayed dark & light adaptation
- Increased sensitivity to glare
- Reduced visual field
- Diminished depth perception
- Altered color vision
- Diminished critical flicker fusion
- Slower visual information processing
58
Risk Factors
Hearing
Non-Modifiable Risk Factors
- male gender
- increased age
- genetic predisposition
Modifiable Risk Factors
- Impacted cerumen
-Ototoxic medications
-diabetes
-smoking
-loud noises
59
Ototoxic Medications
- Aminoglycosides
- Aspirin
- Loop diuretics (bumetanide, furosemide)
- Quinine
- Chemotherapeutic agents
- Macrolides (erythromycin, clarithromycin)
- Non-steroidal anti-inflammatory agents
- Quinolones (ciprofloxacin, ofoxacin)
60
Cataracts
- Characterized by cloudy, dim or blurred vision, ↑sensitivity to glare, ↓contrast sensitivity, double vision, seeing halos around bright lights
Clinical Manifestations
- Painless, blurry vision, surroundings dimmer
- Sensitivity to glare
- Reduced visual acuity
- Other: astigmatism, diplopia, color shifts to brown
Diagnostic
- Decreased visual acuity, opacity of lens by ophthalmoscope, slit lamp, or inspection
61
Age Related Macular Degeneration
- Dry AMD: Caused by death of photoreceptors, gradual
-Wet: blood vessels that hemorrhage into macula, rapid onset
-Mixed
Clinical Manifestations
- Gradual progressive loss of central vision, distorted straight lines & blurred vision
62
Glaucoma
- Three major signs of glaucoma: Increased IOP, optic nerve damage and visual field loss
-main is opitc nerve damage
Clinical Manifestations
- "Silent thief" of vision (open angle)
- Pain, nausea, headache (closed angle)
Diagnostic
- Tonometry to assess IOP/ Ophthalmoscopy to inspect optic nerve disc/central vision testing
63
Nursing Interventions
Hearing
- Prevention of hearing loss: limit exposure to loud noise or use ear protectors, prevent/alleviate impacted cerumen, quit smoking
- Assisting to compensate for hearing deficits: evaluation for a hearing aid, assistive hearing devices, or aural rehabilitation services
- Facilitating optimal communication: eliminate noise and distractions; sit in front of, and close to the person, talk with moderate loudness & slow pace, supplement verbal communication with nonverbal cues or writing
64
Nursing Interventions
Vision
- Identify treatable conditions at an early stage
- Address modifiable risk factors (e.g., smoking, exposure to sunlight)
- Nutritional interventions
- Comfort measures for dry eyes
- Environmental modifications (e.g., optimal illumination, low-vision aids)
- Providing vision-friendly teaching materials
- Glycemic & BP control (prevent diabetic & hypertensive retinopathy
65
Hearing Aid Care
- Keep fresh batteries available (short shelf life)
- Turn off the hearing aid before changing the battery
- Remove the battery or turn off the aid when not in use
- Clean weekly
- Never use alcohol on the earmold- clean with soap/water
- Inspect tubing for earwax and clean with special wire
- Avoid dropping (handle over soft surface)
66
Assess Decision Making Capacity
- MacArthur Competency Assessment Tool for Treatment (MacCAT-T) is widely used
- Nursing responsibility: document specifically and descriptively what are patient's/surrogate's understanding & wishes
67
Elder Abuse
Intentional actions that cause harm or create a serious risk of harm (whether or not harm is intended) to a vulnerable elder by a caregiver or other person who stands in a trust relationship, or failure by a caregiver to satisfy the elder's basic needs or to protect the elder from harm
68
Physical Abuse
Signs
- Broken bones
- Bruises
- Head trauma
- Bruising on areas of body like abdomen/back
- Signs of strangulation
- Inconsistent stories or stories that don't line up
69
Sexual Abuse
Signs
- Unexplained STIs
- Bruises on thighs/genitals
- Bleeding on thighs/genitals
- Inappropriate relationships between caregiver and elder
70
Financial Abuse
Signs
- Large sums of money missing from bank statements
- Cannot access own bank records
- Provides monetary gifts in exchange for companionship
- Unexplained transactions
71
Emotional Abuse
Inflicting mental pain, anguish, instilling fear or distress on an older adult through verbal or nonverbal acts
Signs
- Hesitation to talk freely
- Isolation
- Suffering from anxiety/depression
72
Neglect
- Failure to provide food, shelter, healthcare, or protection to a vulnerable older adult by the caregiver
Signs
- Pressure ulcers
- Lack of basic hygiene
- Missing medical supplies (walkers, dentures, medications)
- Uninhabitable living conditions
73
Abandonment
- Desertion of vulnerable older adult for anyone who has assumed the responsibility or custody of care of the individual
Signs
- Being left alone without food
- If they cannot care for themselves and are left alo
74
Scams
- Phone and email scams are incredibly prevalent
- Important to educate the older adult about to help avoid becoming the victim of this type of elder abuse
75
Self-Neglect
- Failure of a person to perform essential self-care tasks
Threatens their own health/safety
Signs
- Failure to thrive
- Can warrant involuntary hospitalization
76
Risk Factors of Abuse
- Functional dependence or disability
- Poor physical health
- Cognitive impairment
- Low income
- Being Female
- Financial Dependence
- Race/ethnicity (Hispanic experience lowest rates of elder abuse)
Perpetrator risk factors
- Mental health issues
- Substance use issues
- Dependency on older adult
- Ineffective coping - high rates of stress
Societal risk factors
- Ageism
- Cultural norms
77
Abuse Screening
- United States Preventive Services Task Force screening tool: Elder Mistreatment Assessment
- Patients should be interviewed by themselves to avoid intimidation by possible abusers
- Asked about family situation and living arrangements
- Patients should be asked directly about abuse
- assess for signs of abuse
78
Nursing Responsibilities of Abuse
Mandated Reporting
- Any person having reasonable cause to believe that an older adult, or someone within the state who is 60 years of age or older, is in need of protective services may report such information to the agency which is the local provider of protective services
The first obligation of a nurse is to assure the safety of the older adult
79
Age Related Changes
Medications
- Body composition: Less water & muscle mass, more fat, distribution is proportionate based on target of drug (water- soluble, protein binding, lipophilic)
- Hepatic changes: Slowed hepatic metabolism, decreased first pass, changes in enzyme function
- Renal function: Decreased renal excretion, increased half life
- Receptor sensitivity: decreased activity to beta blockers, furosemide, dopamine, propranolol = delayed signs of toxicity ; increased sensitivity to narcotics, alcohol, bromides, ACEis, diazepam= higher potency
80
Beers Criteria
- Suggests drugs to avoid and highlights high alert medications & patients
High alert medications
- Anticholinergic activity
- Benzodiazepines
- Tricyclic antidepressants
- Warfarin
- NSAIDs
- Fluoxetine
- Digoxin
- Oxybutynin
81
Important Drug Interactions
Drugs with narrow therapeutic index (Low Safety Margin)
- Aminoglycosides, Digitalis, Lithium
Drugs affecting vital physiology of the body
- Antihypertensive drugs, Anti-diabetic drugs, Anticoagulants
Drugs with high plasma protein binding capacity
- NSAIDs, Warfarin, Sulfonylureas
Drugs metabolized by Zero Order Kinetics or Saturation Kinetics
- Phenytoin, Theophyllin
