Nursing Care of the Older Adult in
Chronic Illness
Risks factors associated with chronic illness
• Unhealthy diet
• Physical inactivity
• Tobacco use
• Harmful alcohol use
• Infectious agents
• Pollution
• Psychosocial and genetic factors
• Poverty
• Ageing is a marker of accumulation of these risks factors
Health Problems
• Leading causes of death in people ages 65 and over
• Heart disease
• Cancer
• Cerebrovascular disease (stroke)
• Lower respiratory disease
• Pneumonia/influenza
• Diabetes mellitus
Injuries
• Falls
• Leading cause of morbidity, mortality
• Driving
• Fires
• Hypothermia
• Dementia
• Increasing safety needs due to impaired judgment
Chronic Disabling Illness
• Arthritis
• Osteoporosis
• Heart disease
• Stroke
• Obstructive lung disease
• Hearing and visual alterations
• Cognitive dysfunctions
• Many changes to client and family
Drug Abuse and Misuse
• OTC drugs often not reported by client as part of medicine
regimen
• Increased risk for drug interactions
• Potential misuse when more than one primary care provider
prescribes medications
• Obtain all medications from one pharmacy
• Altered pharmacodynamics
Alcoholism
• Early-onset drinkers
• Late-onset drinkers over age 60
• Includes a higher number of women
• Progressive liver, kidney, stomach damage
• Interaction with effects of medication
• Clients should not be prejudged
• Facilitate treatment of drinking problem, prevention of complications
Dementia
• Progressive loss of cognitive function
• Delirium
• Acute, reversible syndrome
• Alzheimer disease
• Most common type
• Lasts between 7–15 years, ending in death
• Caregiving complicated when client no longer recognizes family, friends
Mistreatment of Older Adults
• Physical, psychological, emotional, sexual, financial abuse or
neglect
• Victims most often women over age 75 who are physically or
mentally impaired and dependent on caregiver
• Older adults at home may fail to report
• Be familiar with laws regarding the report of suspected or known
abuse
Adjusting to Changes of Aging
•Rest more
•Curtail driving
•Cane/walker for
mobility
•Diet/nutritional
changes
•Ageism
Adjusting –
Older Adult is making many psychosocial adjustments
• Retirement
• Reduced income
• Spouse’s health
• Social roles
• Living arrangements
• Role reversal
Common health problems
• Heart disease, cancer, stroke
• Poly-Pharmacy
• Accidents, falls
• Arthritis
• Chronic illness
• Elder Abuse
Mental Health Problems in the Older Adult
• Depression: most common affective disorder
• Risk for suicide is increased
• Substance abuse
• Delirium: acute, confused state that begins with disorientation
• If not immediately evaluated and treated, can progress to changes in level of consciousness,
irreversible brain damage, and sometimes death
Dementia
• Symptoms subtle in onset
• Progress slowly
• Alzheimer’s most common: accounts for 70% of dementia
• Non-Alzheimer’s: degenerative, vascular, neoplastic, demyelinating, infectious,
inflammatory, toxic, metabolic, and psychiatric disorders
Alzheimer's
• Complex brain disorder
• Sixth leading cause of death
• Affects half of those 85 and older
• Not a normal aging process
• Two types
• Familial/early onset
• Sporadic/late onset
Nursing Management of Alzheimer's
• Supporting cognitive function
• Promoting physical safety
• Promoting independence in self-care activities
• Reducing anxiety and agitation
• Improving communication
• Providing for socialization and intimacy needs
• Promoting adequate nutrition
• Promoting balanced activity and rest
• Supporting home, community and transitional care
Geriatric Syndromes
• Geriatric triad: cognitive changes, falls, incontinence
• Impaired mobility
• Dizziness
• Falls, falling
• Urinary incontinence
• Susceptibility to infection
• Altered pain, febrile responses
• Altered emotional impact
• Altered systemic response
Elder Neglect and Abuse
• Physical
• Psychosocial
• Emotional
• Sexual
• Abandonment
• Financial exploitation
Potential Economic Effects
• Social services
• Health care costs of aging
• Home health care
• Hospice services
• Aging with a disability
Nursing Management #1
• Supporting cognitive function
• Promoting physical safety
• Promoting independence in self-care activities
• Reducing anxiety, agitation
• Improving communication
Nursing Management #2
• Providing for socialization, intimacy needs
• Promoting adequate nutrition
• Promoting balanced activity, rest
• Supporting home- and community-based care
Pharmacologic Aspects
• Polypharmacy: administration of multiple medications at the same time;
common in older persons with several chronic illnesses
• Aging changes alter drug:
• Absorption
• Metabolism
• Distribution
• Excretion
Nursing Implications
• Need adjustment of dosage due to age; “start low, go slow”
• Assess knowledge of medications and use
• Review need for medication, coordination of prescriber
• Factors that affect compliance
• Keep medication regimen as simple as possible
• Strategies to improve compliance
Cognitive Abilities and Aging
• Piaget's phases end with formal operations phase
• Research on cognitive abilities and aging currently being
conducted
Perception
• Depends on acuteness of senses
• Changes in nervous system
• Brain loses mass.
• Blood flow to brain decreases.
• Meninges thicken.
• Brain metabolism slows.
• Lifelong mental activity maintains high level of cognitive function
Cognitive Agility
• Intellectual loss generally reflective of disease process such as
atherosclerosis
• Blood vessels narrow
• Perfusion of nutrients to the brain diminishes
• Most older adults do not experience cognitive impairments.
• More prevalent in persons over age 85
Memory
• Sensory memory
• Short-term memory
• Past of minutes to a few hours referred to as recent memory
• Most age-related differences short-term
• Long-term memory
• Retrieval may be slower in older adults
Learning
• Additional time needed
• Motivation important
• More difficulty learning information they do not consider
meaningful
• Important to discover what is meaningful to older adult before attempting
client education
Moral Reasoning
• Kohlberg believed moral development to be complete in early
adult years.
• At preconventional level, stage 1, obeys rules to avoid pain and displeasure
of others
• At preconventional level, stage 2, may meet another's needs as well as
their own
continued on next slide
Moral Reasoning
• Kohlberg believed moral development to be complete in early
adult years.
• At conventional level, follow society's rules of conduct in response to
expectations of others
• Moral reasoning does not decline in age.
Moral Reasoning
• Gilligan challenged Kohlberg, as the stages are not applicable to
women.
• Based theory on connectedness and the value of relationships for women
• Kohlberg based his stages on concepts of justice, objectivity, and
preservation of rights.
Moral Reasoning
• Older adults make decisions consistent with both Kohlberg and
Gilligan (i.e., lose gender-based differences).
Moral Reasoning
• Values and belief patterns
• Influence of time period
• Cultural background
• Life experience
• Gender
• Religion
• Socioeconomic status
Reference
• Hinkle, Janice. (2018). Brunner and Suddarth’s Textbook of Medical-
Surgical Nursing. Philadelphia: Lippincott Williams & Wilkins.
Thank you!
