 Update on Gerontology
"This activity has been
approved by the Continuing Nursing Education Network, which is an Approved
Provider of continuing education by CNE-Net, the education division of the
North Dakota Nurses Association, an accredited approver by the American Nurses
Credentialing Center’s Commission on Accreditation. "
INTRODUCTION
PURPOSE
OBJECTIVES
Table of
Contents
Theories Gerontologists historically have identified aging with senescence and decline but organizations like the Gray Panther's advocate that America's elderly are productive members of society in need of programs that support psychological well-being (Bengtson, Rice, and Johnson, 1999). Aging is often associated with terms like decline and death but ageism is now a recognized from of discrimination and will not be tolerated due in part to the Age Discrimination in Employment Act. The
Aging Process The aging process involves changes in cells, tissues, and organs that are engineered by internal factors (genetics) and influenced by external factors (environmental hazards). Each person ages differently depending on many different factors including environment, economics, and education. External Factors
Another external factor is the economical difference between urban versus rural settings. Urban settings include exposure to pollutants and life threatening situations but rural settings exclude access proper medical care. Also consider the difference between levels of education. Education affects social standing, income, and occupation. Consider the difference between levels of economics. Increased education results in better paying occupations that results in higher standards of living (Black, et al, 1997). The nursing profession must be prepared to provide care for geriatric clients from a variety of backgrounds and cultures and one method of preparation is to understand the changes associated with the aging process. Most older adults have at least one of the chronic condition highlighted in Table 1. Table 1
(American Association of Retired Persons). Cellular
Changes Body
Systems Integument Changes
Normal changes that are usually seen as a result of the aging process include thinning of the skin layers, decreased strength and elasticity, decreased blood supply, and delayed wound healing. Secretions from the sebaceous and sweat glands decrease, hair becomes gray and thin, nails become thick, brittle, and hard. Dryness is the most significant skin problem with aging resulting in itching and scaling. Common skin disorders associated with aging include primary and secondary skin lesions, pruritus, psoriasis, pressure ulcers, herpesvirus infections, and skin cancer. For more indepth information about integumentary changes, surf to the Merck Manual.
Since the changes make the skin of the elder more susceptible to changes in humidity, temperature, and other irritants, nursing care should focus on good nutrition, protection of skin, and good hair and nail care. The key to healthy skin for the elder is prevention (Matteson, et al, 1997, Black, et al, 1997). The prevention of pressure ulcers is an important task for nursing when caring for elderly clients. The National Guideline Clearinghouse provides guidelines for the Treatment of Pressure Ulcers including assessment of a pressure ulcer. Musculoskeletal Changes
Normal age related changes include decreased height, redistribution of skeletal muscle and subcutaneous fat, porous bones, muscle atrophy, slowed movement, diminished strength, and stiffening of joints. Common disorders associated with aging include osteoporosis and degenerative joint diseases resulting in pathological fractures. For more indepth information about musculoskeletal changes, surf to the Merck Manual. Nursing assessment and interventions must focus on promoting mobility, comfort, and safety through appropriate exercise, pain relief, and adaptive aids and devices. To assess ambulation in older adults, the nurse can use the Get Up and Go Test (Mayo Clinic, Geriatric Medicine). The goal is to keep the elder free of injury, mobile, and independent (Matteson, et al, 1997, Black, et al, 1997).Cardiovascular Changes
Common disorders associated with aging include hypertension, arteriosclerosis, myocardial infarction and angina, cardiac dysrhythmias, congestive heart failure, valve disease, and peripheral vascular disease. For more indepth information about cardiovascular changes, surf to the Merck Manual.
Respiratory Changes
The lungs are constantly exposed to the environment and lung diseases are common with the elder. Risk factors that further decrease lung function are smoking, obesity, and immobility. Common disorders include COPD (emphysema, bronchitis, asthma), pneumonia, tuberculosis, lung cancer, and sleep apnea. For more indepth information about respiratory changes, surf to the Merck Manual. Nursing interventions should focus on minimizing risk factors, managing medications, and keeping the airway patent (Matteson, et al, 1997, Black, et al, 1997).Neurological Changes
Structural changes that occur with normal aging include loss of neurons and brain weight, accumulations of lipofuscin in the neuronal cytoplasm, slowed synaptic transmissions, and loss of peripheral nerve function. Functional changes include slowed reaction time, a decline in proprioceptive capacities, impaired thermoregulation, and changes in EEG and sleep patterns. Common disorders include delirium and dementia. These conditions cause impairments in cognition, reasoning, judgment, and orientation, which in turn cause declines in functional status. For more indepth information about neurological changes, surf to the Merck Manual. Nursing intervention most focus on support and encouragement especially to the families as care of the elder often is the responsibility of the family (Matteson, et al, 1997, Black, et al, 1997).Gastrointestinal Changes
Some age related changes that probably occur in the GI system include decreases in the blood flow to the organs, the size of the organs, and motility. Common disorders include periodontal disease, malignant lesions, dysphagia, hiatal hernia, gastritis, peptic ulcer disease, malabsorption syndromes, diverticulur disease, pancreatitis, hepatitis, cirrhosis, cholelithiasis, and cholecystitis. These disorders produce problems with nutrition and elimination resulting in pain, discomfort, anorexia, constipation, and diarrhea. For more indepth information about gastrointestinal changes, surf to the Merck Manual.
Genitourinary Changes
Normal changes in the GU system include loss of nephrons and renal mass, sclerotic changes in the renal blood vessels, and diminished renal blood flow, decreased creatinine clearance, and a decline in the endocrine functions of the kidneys. Bladder changes include replacement of the smooth muscle and elastic tissue with fibrous connective tissue, reduction in bladder capacity, and loss of bladder control. In women, the external genitalia and vagina may atrophy and become less elastic; in men, there may be alterations in blood flow to the penis with erectile dysfunction. Common disorders associated with aging include acute and chronic renal disease, benign prostatic hypertrophy, cancer of the prostate and bladder, urinary tract infections, and urinary incontinence. For more indepth information about genitourinary changes, surf to the Merck Manual.
Endocrine Changes
Major changes occurring in the older make include decreases in testicular volume and spermatogenesis; however, serum testosterone levels remain constant. Females experience menopause, decreased serum estrogen levels, and atrophy of the subcutaneous tissues of the breast and external genitalia. Sexual responses tend to become slower and are less intense in both men and women. Common disorders associated with the endocrine system include type II diabetes mellitus, thyroid disorders, and cancer of the breast and reproductive organs. For more indepth information about endocrine changes, surf to the Merck Manual. Nursing interventions are aimed toward proper management of medications, diet and exercise, and sexual counseling (Matteson, et al, 1997, Black, et al, 1997).Special Senses Changes
Hearing loss is highly associated with aging. Common disorders include conductive, sensorineural, and mixed hearing loss. Hearing loss for high frequencies is especially common, and older people often have difficulty distinguishing words spoken too fast. Presbycusis, which is frequently found in older age, produces bilateral loss of hearing acuity, poor discrimination and comprehension, and tinnitus. For more indepth information about special senses changes, surf to the Merck Manual. The senses of taste, smell, and touch are thought to diminish with older age; however, more studies are needed in these areas.Nursing assessment and interventions are focused on maximizing the ability to see, hear, taste, smell, and touch. Older people and their families should be taught to use more effective methods of communication and to use aids for communication, such as hearing aids and glasses. These measure help to promote functional independence and well being in elders (Matteson, et al, 1997, Black, et al, 1997).
Dressing
Changes and Wound Care MERLOT Learning
Object
As people reach age 60, their risk for adverse response to medications increases because of their medical status, likelihood of having one or more chronic illnesses associated with aging, and concurrent use of many drugs (polypharmacy). Numerous organs are necessary for the effective elimination of medications including the heart, liver, and kidneys. Each organ is responsible for the elimination of medications. While the heart pumps blood to the various organs, both the liver and the kidneys are necessary to eliminate medications. The liver is responsible for the metabolism of medications and the kidneys are responsible for the excretion of medications. When the function of these organs are affected by chronic illness, medications accumulate in the system resulting in toxicity. Chronic illnesses such as congestive heart failure, liver disease, or kidney failure are associated with medication toxicity (F.A. Davis). For more indepth information about drug therapy for the elderly, surf to the Merck Manual. Summary
Kresevic and Mezey (1999) found that 20 to 40% of all elders experience functional decline during hospitalization. They were able to identify risk factors for functional decline including injuries, acute illness, medication side effects, depression, malnutrition, and decreased mobility. Nurses have the opportunity to monitor activities of daily living (bathing, dressing, eating, toileting, hygiene, and transferring) to assess for any decline in self-care activities. One of the most important concepts to remember is that the nurse is in the best position to compare a comprehensive functional assessment to a baseline assessment to promote identification of underlying problems. This is why the head-to-toe assessment remains one of the most proactive methods of identifying and preventing complications. Bengtson, V.L, Rice, C.J. & Johnson, M.L. "Are Theories of Aging Important? Models and Explanations in Gerontology at the Turn of the Century" in Bergtson, V.L. & Schaie, K.W. (1999). Handbook of Theories of Aging. New York: Springer Publishing Company. Black, J. M. & Matassarin-Jacobs, J. (1997). Medical-Surgical Nursing: A Clinical Management for Continuity of Care (5th ed.). Philadelphia, PA: W. B. Saunders Company. Craven, R. F. & Hirnle, C. J. (2002). Fundamentals of Nursing: Human Health and Function (4th ed.). Philadelphia, PA: Lippincott Williams & Wilkins. Kresevic, D. M. & Mezey, M. "Assessment of Function: Critically Important to Acute Care of Elders" in Abraham, I., Bottrell, M. M., Fulmer, T., & Mezey, M. D. (1999). Geriatric Nuring Protocols for Best Practice. New Yori: Springer Publishing Company. Matteson, M. A., McConnell, E. S., & Linton, A. D. (1997). Gerontological Nursing: Concepts and Practice (2nd ed.). Philadelphia, PA: W. B. Saunders Company. Mayo Clinic, Geriatric Medicine: Practical Functional Assessment of Olders Persons Merck Manual of Diagnosis and Therapy. MERLOT (Multimedia Educational Resources for Learning and Online Teaching). Needham, J. F. (1993). Gerontological Nursing: A Restorative Approach. Albany, NY: Delmar Publishers Inc.
|
