Objectives + Key terms: Chapter 23 The aging process
Ageism - attitudes that stereotype the older adult on the basis of chronologic age
Alzheimer disease - type of dementia in which discrete patches of brain tissue degenerate; this devastating disease
eventually affects all body functions
Delirium - a temporary state of confusion
Dementia - organic impairment of intellectual functioning, gradually leading to interference with social or
occupational functioning, memory, and often personality integration.
Functional health - level of health de ned by one’s ability to carry out usual and desired daily activities
Polypharmacy - the use of many medications at the same time
Reality orientation - used to re-engage a confused person's memory and self-directed behaviors.
Reminiscence - period in a chronic illness when the disease is present, but the person does not experience symptoms
of the disease
Body image - how a person experiences one’s body
Self-actualization - reaching of one’s potential through full development of one’s unique capabilities
Self-concept - mental image or picture of self; includes body image, subjective self, ideal self, and social self
1. Identify normal physiological changes in the older adult.
> See BOX 23-3 Pg. 573 in book for more details
• Physical strength and health ( loss of mass and strength of muscles )
● Retirement and reduced income
● Health of spouse
● Relating to one’s age group
● Social roles
● Living arrangements
● Family and role reversal
• Changes in vision and hearing
• Slower re exes and reaction time
• Decreased sensory ability
2. Identify developmental tasks of the older adult.
• Adjusting to physical changes
• Retirement
• Spouse’s death
• Death of a peer
• Changes in living arrangements
• Rede ned relationships
• New activities & interests
3. List common myths and misconceptions about aging.
• Old age begins at 65 years.
● Most older adults are in long-term care facilities.
● Older adults are sick, and mental deterioration occurs.
● Older adults are not interested in sex.
● Older adults do not care how they look and are lonely.
● Bladder problems are a problem of aging.
● Older adults do not deserve aggressive treatment for illnesses.
● Older adults cannot learn new things.
4. De ne physical, cognitive, psychological and social changes related to aging.
• Physiologic: All organ systems undergo some degree of decline; body less ef cient
● Cognitive: Does not change appreciably, may take longer to respond and react
● Psychosocial: Self-concept is relatively stable throughout adult life.
● Disengagement theory: An older adult may substitute activities but does disengage from society.
● Erikson: Ego integrity versus despair and disgust; life review
● Havighurst: Major tasks are maintenance of social contacts and relationships
5. Identify the process of reception, perception, and reaction to sensory stimuli.
Reception - Stimulation of receptors and transmission of impulses to cerebral cortex
Perception - Organization and integration of multiple stimuli into a meaningful pattern
Reaction - Stimuli are stored or discarded by the brain to allow reaction to the most meaningful stimuli
6. Identify classic symptoms and risk factors of dementia and Alzheimer’s disease.
Dementia - slowly progressive decline in cognition
> sundowning syndrome, in which an older adult habitually becomes confused, restless, and agitated
after dark.
> Memory loss
> Personality changes
> Impaired judgment
> Emotional changes
> Neuro-pathological impairments
> May affect body functions
Alzheimer’s Disease - Alzheimer’s disease (AD) is the most common degenerative neurologic illness and the
most common of cognitive impairment. It is IRREVERSIBLE and progresses from de cits in memory and
thinking skills to an eventual inability to perform basic self-care.
> Loss of memory, judgement, and visuospatial perception
> Changes in personality
> Progressive cognitive impairment
> Severe physical deterioration
> Death - occurs from the hazards of immobility
Risk factors include: Genetics and chemical imbalances
7. List the attitudes of the well-elderly adult toward healthy living.
Health, active, vibrant, young, physically t
8. Identify health promotion activities for the elderly.
Exercise programs, eating together programs, health education programs, breast self-examination, stress
reduction
9. Identify the speci c risks to safety for elderly clients.
Fall, Over-self medicating, target for crime, sensory losses, automobile accidents, decreased re ex time,
burns and scalds
10. Identify elder abuse and neglect issues.
Elder abuse - “an intentional act or failure to act by a caregiver or another person in a relationship
involving an expectation of trust that causes or creates a risk of harm to an older adult”
> Physical abuse is the intentional use of physical force that results in acute or chronic illness, physical
injury, pain that can range from physical discomfort to agony, functional impairment, distress in the
form of mental or physical suffering, or death.
> Sexual abuse involves forced or unwanted sexual interaction of any kind with an older adult, including
touching and nontouching acts (such as photography, voyeurism, verbal or behavioral sexual harassment,
or forced viewing of pornographic materials).
> Emotional or psychological abuse includes verbal or nonverbal behavior that results in the caregiver or
trusted person in icting anguish, mental pain, fear, or distress.
> Financial abuse or nancial exploitation involves the illegal, improper, or unauthorized use of the
resources of an older adult by the caregiver or trusted person for the bene t of someone other than the
older adult.
> Neglect involves failure by the caregiver or person in a trusted relationship to protect an elder from
harm, or failure to meet the need for essential medical care, nutrition and hydration, activities of daily
living (hygiene, clothing), or shelter that results in serious risk of compromised health or safety.
11. Identify common terms used to describe the well-elderly population.
> Healthy, active, vibrant, young, physically t
12. List the in uence of drug actions and usage (polypharmacy) in older adults
> Polypharmacy, the use of many medications at the same time, can pose many hazards for older adults.
Chapter 44: Sensory Functioning
1. Identify factors that in uence sensory function.
> Developmental stage
> medications that effect the senses
> environmental conditions - lack of or overstimulation
> Illness (I.e. PVD, CVA, DM)
> smoking may impair taste
> high noise level
> Endotracheal intubation or tracheotomy impairs speech
2. List the types of sensory alterations and their effects.
Sensory overload - condition resulting from excessive sensory input to which the brain is unable to meaningfully respond
Sensory deprivation - condition resulting from decreased sensory input or input that is monotonous, unpatterned, or
meaningless
> Perceptual disturbances
> Cognitive disturbances
> emotional disturbances
Sensory de cits - impaired or absent functioning of one or more senses
> Impaired sight and hearing
> altered taste
> numbness and paralysis
> altered tactile perception
> impaired kinesthetic sense
Sensory poverty - condition that results when one learns about the world without experiencing it up close, right here,
right now
3. Identify behaviors that indicate sensory overload and deprivation.
> Social isolation
> Confusion
> Irritability
> Clumsiness
> Increased anxiety
4. Identify guidelines for clients with learning and speech impairments.
Hearing/Speech Impairments -
•Hearing aid in place/working
•Get patient’s attention
•Face the patient
•Speak slowly/ Do not shout
•Speak in “best” ear
•Use visual aids such as word or letter boards
•Use sign language interpreter
•Paper and pen
Visual Impaired -
•Knock prior to entry
•Announce entry into room
•Braille handouts, audio-taped education
•Arrange food on plate in formation of a clock
•Keep clutter free
•Establish environment and limit changes
•Offer arm for support with ambulation
•Indicate steps, change in oor surface
OER:
Identify classic symptoms and risk factors of glaucoma and cataracts.
• Glaucoma - is a disturbance of the functional or structural integrity of the optic nerve. Decreased uid drainage or
increased uid secretion increases intraocular pressure (IOP) and can cause atrophic changes of the optic ner ve and
visual defects. The expected reference range for I0P is 10 to 21 mm/Hg.
> Classic Symptoms: mild eye ache, reduced night vision, halos around lights, blurred, photophobia, pressure like eye
pain, nausea and vomiting
> Risk factors:
Age
Infection
Tumors
Diabetes Mellitus
Genetic predispositions
Hypertension
Eye trauma
Severe myopia
Retinal detachment
• Cataracts - An opacity of the lens, a common cause of vision loss.
> Classic Symptoms: Milky white lens, painless, better vision in dim light, headlight glare at night, blurred vision,
diplopia ( double vision ), decreased visual acuity
> Risk factors:
Advanced age
Diabetes
Heredity
Smoking
Eye trauma
Excessive exposure to the sun
Chronic use of corticosteroids, phenothiazine derivatives, beta blockers, or miotic medications
Medications: Generic name is always lowercase
donepezil (Aricept) - used to help improve mental function in people with treat Alzheimer’s.
Donepezil comes as a tablet and an orally disintegrating tablet (tablet that dissolves quickly in the mouth) to take by mouth. It
helps control the symptoms of Alzheimer's disease but does not cure it.
> For oral dosage forms (oral disintegrating tablets, oral solution, and tablets):
For mild to moderate Alzheimer's disease:
Adults—5 milligrams (mg) taken at bedtime. Your doctor may increase your dose as needed. However, the dose usually is not more
than 10 mg per day.
> Side effects:
Nausea & vomiting
Loss of appetite
Frequent urination
Diarrhea
Weight loss
Muscle cramps
Headache & dizziness
Changes in behavior or mood
Pain
Joint pain, swelling, or stiff
Red, scaling, itchy skin
memantine (Namenda) - reduces the actions of chemicals in the brain that may contribute to the symptoms of Alzheimer's
disease. Moderate to severe. Comes as a tablet, a solution (liquid), and an extended-release (long-acting) capsule to take by mouth.
> Side effects: For treatment of Alzheimer's disease:
Headache & dizziness For oral dosage form (extended-release capsules):
Aggression Adults—At rst, 7 milligrams (mg) once a day. Your doctor may gradually
Nausea & vomiting increase your dose as needed. However, the dose is usually not more than 28
Weight gain mg per day.
Diarrhea
Constipation For oral dosage form (solution and tablets):
Adults—At rst, 5 milligrams (mg) once a day. Your doctor may gradually
increase your dose as needed. However, the dose is usually not more than 10
mg t wo times a day.
pilocarpine hydrochloride ( Isopto Capone, Ocu-Carpine, Pilocar, Pilopine-HS ) - used to treat glaucoma and other eye
conditions. Ophthalmic route ( inserted through the eyes )
For ophthalmic dosage form (eye drops):
For chronic glaucoma:
Adults and children—Instill one drop 1 to 4 times a day.
For acute angle-closure glaucoma:
Adults and children—Instill one drop every 5 to 10 minutes for three to six doses. Then one drop every one to
three hours until eye pressure is reduced.
For ophthalmic dosage form (eye gel):
For glaucoma:
Adults and teenagers—Use once a day at bedtime.
For ophthalmic dosage form (eye insert):
For glaucoma:
Adults and children—Insert one ocular system every seven days.
> Side effects:
Increased sweating
Muscle tremors
Nausea, vomiting, diarrhea
Redness of the white part of the eyes or of the eyelids
Trouble breathing
Watering of mouth
timolol ( Timoptic ) - (for the eyes) is used to treat open-angle glaucoma and other causes of high pressure inside
the eye.
Usual Adult Dose for Intraocular Hypertension & Glaucoma ( open angle):
Gel-forming Solution: 1 drop of 0.25% or 0.5% solution instilled in the affected eye(s) once a day
Maximum dose: 1 drop of 0.5% solution once a day
Long-acting solution: 1 drop of 0.5% solution instilled in the affected eye(s) once a day in the morning
> Side effects:
burning or stinging in your eye;
dry eyes, itching;
feeling like something is in your eye;
red or puffy eyelids; or
headache.
atropine sulfate ( Atropine Care 1% , Atropisol , Isopto Atropine , Ocu-Tropine ) - used before eye examinations to dilate
(open) the pupil, the black part of the eye through which you see. It is also used to relieve pain caused by swelling and
in ammation of the eye. Comes as a solution (liquid) to instill in the eyes and an eye ointment to apply to the eyes.
For ophthalmic dosage form (eye drops):
For mydriasis, cycloplegia, and amblyopia:
Adults and children 3 months of age and older—Use one drop 40 minutes before the intended maximal dilation time.
> Side effects:
eye irritation and redness
swelling of the eyelids
sensitivity to bright light
dry mouth
red or dry skin
blurred vision
acetazolamide ( Diamox ) - used to treat glaucoma, a condition in which increased pressure in the eye can lead to
gradual loss of vision. Acetazolamide decreases the pressure in the eye. Available asTablets and modi ed-release
capsules.
Diamox is provided as a tablet of 125 and 250 milligrams (mg), and as an extended-release capsule of 500 mg. It can
also be given intravenously. The usual dose is 250 mg tablets up to four times a day, or 500 mg extended release capsule
t wice per day. In the management of acute close-angle glaucoma, Diamox is sometimes given intravenously to rapidly
reduce eye pressure while awaiting surgery, typically at a dose of 500 mg.
> Side effects:
Lightheadedness and dizziness
Increased urination
Dry mouth
Blurred vision
Loss of appetite
Nausea
Headache
Tiredness
Blurred vision
Increased blood sugar
Increased sensitivity to the sun
