CARE OF OLDER ADULT REVIEW GUIDE

CARE OF OLDER ADULT REVIEW GUIDE Care of The Older Adult Chapter 1, 2 & 3 Gerontology is the broad term used to define the study of aging and/or the aged. Geriatrics is often used as a generic term relating to older adults, but specifically refers to the medical care of older adults. Geriatricians are physicians trained in geriatric medicine. ● “old” is often defined as over 65 years of age ● young old (ages 65–74 ● middle old (ages 75–84), ● old frail elders (ages 85 and up) Genomics is the identification of gene sequences in the DNA-Study of all human genes Genetics is the study of heredity and the transmission of certain genes through generations—Study of individual genes Sociological Theories- Changing roles, relationships, status, and generational cohort impact the older adult’s ability to adapt. ● Activity - Remaining occupied and involved is necessary to a satisfying late life. Society expects retirees to remain active in their communities. ● Disengagement -Gradual withdrawal from society and relationships serves to maintain social equilibrium and promote internal reflection. ● Subculture -The elderly prefer to segregate from society in an aging subculture sharing loss of status and societal negativity regarding the aged. Health and mobility are key determinants of social status. ● Continuity -Personality influences roles and life satisfaction and remains consistent throughout life. Past coping patterns recur as older adults adjust to physical, financial, and social decline and contemplate death. Identifying with one’s age group, finding a residence compatible with one’s limitations, and learning new roles postretirement are major tasks. ● Age stratification -Society is stratified by age groups that are the basis for acquiring resources, roles, status, and deference from others. Age cohorts are influenced by their historical context and share similar experiences, beliefs, attitudes, and expectations of life-course transitions. ● Person-Environment-Fit -Function is affected by ego strength, mobility, health, cognition, sensory perception, and the environment. Competency changes one’s ability to adapt to environmental demands. ● Gerotranscendence -The elderly transform from a materialistic/rational perspective toward oneness with the universe. Successful transformation includes an outward focus, accepting impending death, substantive relationships, intergenerational connectedness, and unity with the universe. Psychological Theories -Explain aging in terms of mental processes, emotions, attitudes, motivation, and personality development that is characterized by life stage transitions. ● Human needs -Five basic needs motivate human behavior in a lifelong process toward need fulfillment. ● Individualism -Personality consists of an ego and personal and collective unconsciousness that views life from a personal or external perspective. Older adults search for life meaning and adapt to functional and social losses. ● Stages of personality -Personality develops in eight sequential stages with corresponding life development tasks. The eighth phase, integrity versus despair, is characterized by evaluating life accomplishments; struggles include letting go, accepting care, detachment, and physical and mental decline. ● Life-course/life span -Life stages are predictable and structured by roles, relationships, values, development, and goals. Persons adapt to changing roles and relationships. Age-group norms and characteristics are an important part of the life course. ● Selective optimization - Individuals cope with aging losses through activity/role selection, optimization, and compensation. Critical life points are morbidity, mortality, and quality of life. Selective optimization with compensation facilitates successful aging. Stochastic Theories - Based on random events that cause cellular damage that accumulates as the organism ages. ● Free radical theory - Membranes, nucleic acids, and proteins are damaged by free radicals, which causes cellular injury and aging. ● Exogenous Sources of Free Radicals ( Tobacco smoke, Pesticides, Organic solvents, radiation, ozone and selected medications) ● Orgel/error theory- Errors in DNA and RNA synthesis occur with aging. Cells accumulate errors in their DNA and RNA protein synthesis that cause the cells to die ● Wear and tear theory- Cells wear out and cannot function with aging. ● Connective tissue/cross-link theory- With aging, proteins impede metabolic processes and cause trouble with getting nutrients to cells and removing cellular waste products. Nonstochastic Theories - Based on genetically programmed events that cause cellular damage that accelerates aging of the organism. ● Programmed theory-Cells divide until they are no longer able to, and this triggers apoptosis or cell death. ● Gene/biological clock theory- Cells have a genetically programmed aging code. ● Neuroendocrine theory - Problems with the hypothalamus-pituitary-endocrine gland feedback system cause disease; increased insulin growth factor accelerates aging. ● Immunological theory- Aging is due to faulty immunological function, which is linked to general well-being. Nursing Theories of Aging ● Functional consequences theory- Environmental and biopsychosocial consequences impact functioning. Nursing’s role is risk reduction to minimize age-associated disability in order to enhance safety and quality of living. ● Theory of thriving- Failure to thrive results from a discord between the individual and his or her environment or relationships. Nurses identify and modify factors that contribute to disharmony among these elements. Chapter 4- Review of Aging of Physiological Systems Summarization of Cardiovascular Structural and Functional Changes That Occur with Age Structural -Decreased myocardial cells, decreased aortic distensibility, decreased vascular tone o Increased heart weight, increased myocardial cell size, increased left ventricle wall thickness, increased artery stiffness, increased elastin levels, increased collagen levels, increased left atrium size Functional -Decreased diastolic pressure (during initial filling), decreased diastolic filling, decreased reaction to beta-adrenergic stimulus o Increased systolic pressure, increased arterial pressure, increased wave velocity, increased left ventricular end-diastolic pressure, elongation of muscle contraction phase, elongation of muscle relaxation phase, elongation of ventricle relaxation No change -Ejection fraction, stroke volume, overall systolic function Aging of the Respiratory System Three main physiological changes occur: These three factors contribute to the functional decline of the respiratory system. ● decline in chest wall ability ● decline in elastic recoil of the lung ● decline in respiratory muscle strength. Aging in Key Components of the Gastrointestinal Tract The two GI areas most affected by age are the upper tract (the pharynx and esophagus) and the colon, also referred to as the large intestine ● The Mouth o Dental decay and tooth loss affect many older individuals today, making it more difficult to chew and prepare food to be swallowed o Dry mouth can be attributed to prescription and over-the-counter medications, nutritional deficiencies, disease, and treatment therapies such as chemotherapy o atrophy of those muscles and bones of the jaw and mouth that control mastication. Consequently, it is more difficult for older adults to chew their food ● The Esophagus o stiffening of the esophageal wall and less sensitivity to discomfort and pain in the esophagus. These changes affect the older patient’s ability to swallow. o The gag reflex also appears to be absent in around 40% of healthy older adults ● The Stomach o declines in peristaltic contractions and stomach emptying do not appear to be clinically significant ● The Small Intestine o no change or only minor changes in contraction intensity with age o prolonged gastric emptying is a decrease in gastric acid secretion ● The Large Intestine o Aging women experience a greater risk of anal sphincter changes due to laxity of the pelvic floor, decreased pressure in the rectum, and even menopause o experience longer colonic transit time (the amount of time needed for fluid and excrement to travel the length of the colon). o Increased colonic transit time also correlates with increased fibrosis in the colon Resistance Training and Aging Muscle ● Resistance exercise, exercise aimed at increasing the force generated by muscle, has been shown to have the most beneficial effects ● Resistance training has also been shown to improve muscle quality Age-Related Disease and Injury of the Bone ● Osteoporosis- reductions in bone quantity and strength. Generally very porous, containing numerous holes or empty pockets. They are thin and fragile and, consequently, extremely prone to fracture ● Bone Fracture- Fractures in elderly persons often occur as the result of only minimal or moderate trauma, whereas in younger persons considerable force is required to fracture a bone. o most common site of fracture is the bone shaft, whereas in older persons fractures generally occur next to a joint Aging of the Joints ● Immovable Joints o With increasing age the collagen between the bones of immovable joints becomes coated with bone matrix. As a result, the space between bones gets even narrower and the bones may eventually fuse together completely. Consequently, the joints become stronger; therefore, with age immovable joints actually improve. ● Cartilaginous Joints o The aging process is associated with a stiffening of the cartilage comprising cartilaginous joints. Ligaments also become stiffer and less elastic. The result of these changes is a reduction in the amount of movement allowed by the cartilaginous joints. ● Synovial Joints o The functional ability of synovial joints begins to decline around 20 years of age. As a person ages, both the joint capsule and the ligaments become shorter, stiffer, and less able to stretch. In addition, the cartilage lining the bones becomes calcified, thinner, and less resilient. Consequently, it becomes more difficult to move, and range of motion and efficiency of the joint are reduced The Sensory System