Geriatric nursing today Flashcards
(37 cards)
What is ageism
- Ageism is “a deep and profound prejudice against the elderly which is found to some degree in all of us
- Results in older persons being “categorized as senile, rigid, and old-fashioned in morality and skills
- Ageism allows those of us who are younger to see old people as ‘different’
- We subtly cease to identify with them as human beings, which enables us to feel more comfortable about our neglect and dislike of them
Ageism in healthcare
- Institute of Medicine reports negative attitudes towards older adults persist in the health care community, across professional disciplines, and across care settings
- Healthcare professionals have a biased experience with older adults because they tend to see and treat only the most frail, and sick older people
- Ageist stereotypes, prejudice, and discrimination are potential barriers for health equality, in terms of the quantity and quality of care provided to older patients and their health-related outcomes
Ageist terms in healthcare
• “Bed blockers”
- Used for generally an older adult who is in an acute care bed (ACL), but framed as someone who is “blocking the bed” for someone else who needs it more
• “Pleasantly confused”
• “GOMER”
- “Get Out Of My ER”
• Elder-speak
- HCP speaking to older adults and infantilizing them
• Non-specific diagnoses (“failure to cope”) (25%)
- Failure to cope/failure to thrive
- Don’t actually mean anything; catch all blanket of diagnoses , doesn’t say anything about how we should be directing their care
- Whose failure is it if they are unable to cope?
• Less likely to be referred for surgery
- Even when the prognosis and recovery time are the same
• Less willing to implement therapeutic strategies to help older suicidal patients
- The underlying belief is that the older adult who is depressed, we don’t really blame them
- Ageism belief that is driving some of these decisions
- Implicit
• The more negative the nurses’ attitudes, the shorter, more superficial, and more task-orientated their conversations with older patients are. The nurse tended to speak to older patients in a patronizing tone, and did not involve them in consultations or decisions
Geriatric syndromes
- Poorly defined: A categorial term used to capture those clinical conditions in older persons that do not fit into discrete disease categories
- Highly prevalent and associated with substantial morbidity and poor outcomes; impact on quality of life and disability
- Multiple underlying factors (running together), involving multiple organ systems, multifactorial health conditions that occur when the accumulated effects of impairments in multiple systems render (an older) person vulnerable to situational challenge (Inouye et al, 2007)
- Chief complaint does not represent the specific pathologic condition underlying the change in health status
- Multiple things that are happening all at the same time that are influencing the vulnerability of the individual
Common geriatric syndromes
• Frailty - Hallmark of geriatric syndromes • Pressure ulcers • Incontinence • Falls • Functional decline • Delirium, dementia & depression • Nutrition & weight loss • Sarcopenia - Loss of muscle • Dizziness & syncope
Risk factors, geriatric syndromes, frailty, and poor outcomes
- All of these things can be caused by multiple organ systems
- Makes care of the older adult complex
- As a RN need to navigate why this is happening to the person (i.e. why is this person falling, why are they getting pressure ulcers? Etc.)
- Frailty is the hallmark of geriatric syndromes
- A geriatric syndrome can cause frailty but in turn frailty can cause a geriatric syndrome; it is not a risk factor
- Risk factors are attributes that increase you likelihood of getting a geriatric syndrome
Shared risk factors for geriatric syndromes
• Older age - Thresholds are by decades • Cognitive impairment - Severity • Functional impairment - ADLs • Impaired mobility • Poor nutritional status • Female gender • Depressive symptoms
Multifactorial complexity of geriatric syndromes
- Linear vs concentric vs interactive concentric models
• Model offers a locus of where to target interventions of multiple pathways contributing to geriatric syndromes
• Complex interactions between an individual’s vulnerabilities and exposure to specific challenges, including non-biological considerations like social determinants of health/economics/social domains - How can we get different risk factors that encompass more than just older age
Profile of older persons entering the healthcare system
• Advanced age
• Heterogeneous group
- Can present with a multitude of different syndromes
• Co-existing multiple chronic health problems
• Changes in function, cognition and nutritional status
- Increased vulnerability for adverse outcome
Sensory impairment
- Nearly 2/3 of people older than 70 have a clinically significant hearing impairment
- The prevalence of healing loss doubles every decade
- Graph: the older you get, the frequency of what you can hear is reduced
Presbycusis
• Sensorineural hearing loss called presbycusis; degeneration of hair cells in the cochlea and otic nerve loss (inner ear); transmission of sound waves to the brain is impaired
- Most common type of hearing loss
• Risk factors: aging, exposure to loud noise; Caucasian, ear structure damage
• Harder to hear consonant sounds
• Women’s voices and children’s voices are harder to hear; hard to talk on the phone
• Harder to hear in noisy environments; can’t separate the target voice from background noise
“Unfair” hearing test
• An interactive listening experience
• Captions will be on; but they are incorrect
- Gave examples of what things would sound like if you had a hearing impairment
Impact of hearing loss: who it impacts
Reduced quality of life for the affected person, with cascading consequences for patient’s families, caregivers, and society
Impact of hearing loss: the older adult
• Sensory loss impedes self-care and management of other chronic health conditions (e.g. receiving education about health issues)
- Example: can’t hear the phone if they have a doctors’ appointment
- Reduces how often they leave their house
• Loss of independence contributes to the higher rates of hospitalization
• Loss of independence adversely affects caregivers, leading to collateral third-person disability in social and daily functioning
Impact of hearing loss: the caregivers
• A systemic review shoes that communication partners experience restricted social life, increased burden of communication, and poorer quality of life and relationship satisfaction
- Treatment of the hearing loss can improve many of these factors
Impact of hearing loss: society
• Reduced speech understanding reduces the ability of the person to engage in society (e.g. engaging in employment, attending social events/being active community member)
- Losing people who could be a part of society, but they can’t communicate with other people
Relevance of hearing loss on cognition
• Sensory impairments increase the risk for costly health outcomes of disability, depression, cognitive impairment, and dementia
• ARHL (age related hearing loss) has been found to be independently associated with poorer cognitive functioning and incident dementia
- Compared to those with normal hearing, seniors with mild, moderate, and severe hearing loss had a 2x, 3s, and 5x increased risk of developing dementia, respectively
- The specific mechanism of why this occurs is unknown
• The specific mechanisms may be related to:
- The effects of hearing loss on cortical processing
- Increasing cognitive load
- Social isolation
Hearing interventions
- Technological devices
- Text message phone devices with closed captioning
- Formal hearing assessment – clinic based audiologic evaluation with audiologist
- Follow up appointments for hearing aid fitting and adjustments if a model of care that remain inaccessible
- Hearing tests: Weber test (tuning form on the forehead); Rinne test (tuning fork on mastoid process)
• Community based interventions are needed to ensure that older adults are able to integrate hearing technologies in their lives
- Only 15% of people who need hearing aids wear them
Hearing interventions: technological devices
- Pocket talker; directional microphones (noise cancelling algorithms, and wireless capabilities that allow seamless integration with smartphones)
- Updated hearing aids (only improves hearing by about 50% because it need to be calibrated to the person’s hearing and wearing them originally can be quite overwhelming)
- Cochlear implant surgery for those who are profoundly deaf; Sunnybrook cochlear implant program
Visual impairment
• 95% of older adults over 65 wear glasses for close vision
• Due to functional and structural changes
- Extraocular; lower lid can turn inward or outward leading to dry eye
- Ocular changes; glaucoma; light fractures; external glare is a problem; colour perception reduced
- Intraocular; less rods reduce in peripheral vision; colour clarity reduced
Impact of visual impairment: Grue 2001 chart
- Reduced quality of life
- Increased chance of mortality and institutionalization
- The older you are, you have less clear vision for a range of reasons
Interventions for vision loss
• Glasses – most have outdated prescription; lost or broken • Technological devices for low vision - Talking clocks - Read out loud devices • Audiobooks, podcasts • Magnifying glasses • Cutlery that is bring red or orange • Make sure adequate lighting in the room
Dual sensory loss
- The sum of these problems is greater than the consequences of each alone
- For example, compare with a single sensory loss, combined hearing and vision loss, termed dual sensory loss, further challenges cognitive functioning in older adults
- Associated with poorer quality of life, increased depression, and even increased mortality risk
Communication with older adults
- One of the most effective intervention of communication is person-centred care
- Person-centred care approaches are essential to effective communication
- Who are they? Get to know your older adult
