KEY LEARNING OBJECTIVES:
At the end of the session, the
participant should be aware of:
• Guidelines for assessment of elderly
and appropriate nursing management.
• Issues related to elderly safety
• Problems faced by the elderly
• Tips for care of the problems
In emerge4ncies, elderly population form one of the
most vulnerable groups due to their physical and
congnitive limitations moreover, in such situations
they are often neglected as the limited resources are
usually directed towards the other victims such as
women and children.
General Guidelines for Assessment of Older persons
While setting does not matter so much but the method
you choose will depend upon various factors i.e. time
you allow for assessment your patient energy levels
the environment the patient (client’s) consent,
language, communication deficits the patient’s attitude
about aging-all affect the overall atmosphere of trust
caring and confidentiality.
Tools for functional assessment
FANCAPES
F-Fluids- state hydration and factors contributing
A-AERATION – (adequacy of oxygen exchange)
N – NUTRITION – Mechanical and psychological factors-
amount and type of food consumed
C-COMMUNICATION- sight and sound, voice quality
adequate functioning of tongue, teeth, pharynx and larynx,
ability to read and understand spoken words
A-ACTIVITY- activity of daily living ADLs, coordination,
balance, strength
P- PAIN
E- EVACUATION – bladder and bowel evacuation
S-SOCIALIZATION- giving and receiving love, function
in society felling of self worth
Sensory changes in Old Age
• Visual changes
• Hearing changes
• Taste and smell
Visual changes
• Presbyopia
• Cataract
• Glaucoma
• Diabetic retinopathy
Auditory changes
• Presbyacusis
• Responds inappropriately
• Isolation
• Misunderstand
Taste and smell
• Blunted
• Prefer stay. Highly seasoned food.
• Dulling of sweet tastes.
The important steps in nursing management including
assessment and interventions are describe4d below.
ASSESSMENT
Nursing Assessment
• Identifying persons at risk
• Physical Assessment
• Ability to perform self care
• Environment
• Social development and support
• Communication methods
• Mental status
• Self perception of sensory loss
Physical Assessment
• Vision
Ask client to read newspaper or magazine, Snellens chart
• Hearing
Audiometry, observe patient conversing with others, Inspect
for ear wax
• Taste
Ask client to dilstinguish different tastes
Ask client if recent weight change has occurred.
• Position change
Hold finger of the patient move it up and down. Repeat
with toe.
• Touch
Assess client’s sensitivity to light touch and temperature,
sharp and full stiumuli.
• Smell
Have client close eyes and identify nonirritating odours
Social development and support
• Visiting relatives and frie4nds
• Assessment of socialization
• Socialization impaired in old clients and those4
with sensory deficits..
Personality traits of deaf adults
• Withdraw from communication with adults who
can hear
• Are less flexible their daily routines
• Demonstrate a negative self image
• Show more dependence
• Lack of social judgment
Communication methods
• Understand the communication
methods, the patient wants to use.
• Sign language read and write notes
listen with hearing aid
• Minimize anxiety in patients with
temporary loss of speech.
Mental status assessment
• Physical appearance and behaviour
• Motor activity
• Posture
• Facial expression
• Hygiene
• Cognitive ability
• Level of consciousness
• Abstract reasoning
• Calculation
• Attention
• Judgment
• Ability to read, write, copy figures
• Recent and remote memory
Emotional stability
• Agitation, euphoria, irritability,
hopelessness, or wide mood swings
• Auditoty, visual, tactile, hallucinations
• Illudions
• Delusions
Self perception of sensory loss
• Effect on quality of life
• Confidence
• Effect on socialization
• Sensory changes are the most likely to cause
isolation.
INTERENTNON
Goals of nursing care
• Provide comfort and wellbeing to the patient
• Decrease anxiety and apprechension
• Maintain optimal function of the senses
• Control the environment and create meaningful stimuli
• Establish a safe environment
• Establish contact with reality
• Prevention of additional sensorty loss
• Communicating effectively
• Achieving self care
• Develop insight
Meaningful environment stimuli
• Visual
• Presence of windows
• Provide flowers, pictures or greeting cards
• Raise the head of the bed. Remove dividing
curtains or partitions
• Keep patient near the window, provide room with
a view.
• Use a watch or clock that verbally tells time
• Television, pictures of family members
• Telephone
• Visitors, other patients
• Call bell: alarm bell
Visual- loss of vision
• Identify name and purpose when entering client’s room.
Identification when entering the room helps the client feel secure
and decreases social isolation.
• Orient to time, place person and surroundings provide a radio or
talking books.
• Keep side rails up sousing half or three-quarter rails and maintain
bed in a low position.
• Conversion with and touch client frequently during care if
frequent touch is within client’s cultural norm. appropriate touch
can decrease social isolation.
• Walk client by having client grasp nurse’s elbow and walk party
behind nurse.
• Orient to time, place person, and surroundings provide a radi9oo
or taking books. These actions help client remain oriented and
provide sensory stimulation
• Keep doors completely open or closed. Keep furniture out of path
to bathroom and do not rearrange furniture. Feed client at
Keep call light button within client’s reach
Ensure access to eyeglasses or magnifying devices as needed.
Pay attention to client’s emotional needs.. Encourage
expression of feelings and expect grieving behavior blind
people grieve the loss of vision and experience a loss of
identity and control over their lives.
Refer to optometrist, ophthalmologist, or specialist in vision
loss for vision care if needed. Treatment of diabetic
retinopathy can greatly reduce the incidence of blindness.
Many client with eye disorders need frequent medical care to
maintain vision
Keep furniture out of path to bathroom. And do not rearrange
furniture. Auditory-hearing loss..
