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Course: Medical Surgical Nursing

Topic: Nurse’s Role in Care of the Elder Population

The Nurses International Community

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NI Privacy Policy and Terms of Use.

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Module Goals:

Learners will be able to:

Outline the physiological changes that occur in the elder population related to body systems and their adaptation.
Explain the psychological changes experienced by members of the aging population and their adaptations.
Explain the social changes experienced by members of the aging population and their adaptations.
Outline the nurse’s role in the care of the aging population in health promotion, disease prevention, and quality of life.

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Late Adulthood

Age 60 and beyond
Changes include changes in:

Physical
Cognitive
Social capabilities and needs

Stangor & Walinga, 2014

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Late Adulthood: Physical Changes

Heart muscle thicken
Arteries less flexible
Lung capacity diminishes
Kidneys less efficient
Bladder loses the ability to store urine
Brain cells lose some functioning
Other changes

Skin
Hair
Nails
Height
Weight

University of Arkansas, 2020

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Late Adulthood: Body Changes

Lean tissue loss
Loss of some cells in muscles, liver, kidney, and other organs.
Bones may lose some of their minerals and become less dense:

Osteopenia in the early stages
Osteoporosis in the later stages

Older adults have more fat composition as they age

University of Arkansas, 2020

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Late Adulthood: Skin, Hair, Nails

Skin becomes thinner, less elastic, and loses subcutaneous tissue.

Skin sags and wrinkles
Veins and bones are more easily seen
Scratches, cuts, and bumps may take longer to heal

Hair loss is common/ rate of hair growth slows
Nails, become hard and thick

Lengthwise ridges may develop in the fingernails and toenails

University of Arkansas, 2020

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Late Adulthood: Height and Weight

Loss of almost one-half inch every 10 years after age 40
More rapid after age 70
Total of 1 to 3 inches in height
Men often gain weight until about age 55 and then lose weight later in life.
Women usually gain weight until age 65 and then begin to lose weight.

University of Arkansas, 2020

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Late Adulthood: Sensory Changes

Senses show signs of decline:

Vision

Cataracts
Macular degeneration
Glaucoma

Hearing

Presbycusis
Tinnitus

University of Arkansas, 2020

Contact info: info@nursesinternational.org

Vision:

Cataracts are a clouding of the lens of the eye. The clarity of the lens is reduced. Cataracts also cause a discoloration of the lens, tinting it more yellow and then brown, which can interfere with the ability to distinguish colors such as black, brown, dark blue, or dark purple.
Older adults are also more likely to develop age-related macular degeneration, which is the loss of clarity in the center field of vision due to the deterioration of the macula, the center of the retina.
A third vision problem that increases with age is glaucoma, which is the loss of peripheral vision, frequently due to a buildup of fluid in the eye that damages the optic nerve.

Hearing:

Almost 1 in 4 adults aged 65-74 and 1 in 2 aged 75-older have disabling hearing loss.
Presbycusis is a common form of hearing loss in late adulthood that results in a gradual loss of hearing.

Older adults may also notice tinnitus, a ringing, hissing, or roaring sound in the ears.

Taste and smell:

This loss of smell due to aging is called anosmia.

Touch:

Reduced or changed sensations of vibration, cold, heat, pressure, or pain.

Pain:

According to Molton and Terrill (2014), approximately 60%-75% of people over the age of 65 report at least some chronic pain, and this rate is even higher for those living in nursing homes.

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Late Adulthood: Sensory Changes

Senses show signs of decline:

Taste and smell

Presbyosmia
Hyposmia

Touch

Reduced in sensation
Cold
Heat

Chronic pain

University of Arkansas 2020

Contact info: info@nursesinternational.org

Vision:

Cataracts are a clouding of the lens of the eye. The clarity of the lens is reduced. Cataracts also cause a discoloration of the lens, tinting it more yellow and then brown, which can interfere with the ability to distinguish colors such as black, brown, dark blue, or dark purple.
Older adults are also more likely to develop age-related macular degeneration, which is the loss of clarity in the center field of vision due to the deterioration of the macula, the center of the retina.
A third vision problem that increases with age is glaucoma, which is the loss of peripheral vision, frequently due to a buildup of fluid in the eye that damages the optic nerve.

Hearing:

Almost 1 in 4 adults aged 65-74 and 1 in 2 aged 75-older have disabling hearing loss.
Presbycusis is a common form of hearing loss in late adulthood that results in a gradual loss of hearing.

Older adults may also notice tinnitus, a ringing, hissing, or roaring sound in the ears.

Taste and smell:

This loss of smell due to aging is called anosmia.

Touch:

Reduced or changed sensations of vibration, cold, heat, pressure, or pain.

Pain:

According to Molton and Terrill (2014), approximately 60%-75% of people over the age of 65 report at least some chronic pain, and this rate is even higher for those living in nursing homes.

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Case Study/ Critical Thinking Question/ What Would the Nurse Do?

An older adult complains that their skin feels dry all the time.

What would the nurse tell the client about the causes and remedies for dry skin?

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Late Adulthood: Psychological Changes

Erikson: Integrity vs. Despair:

Individuals reflect on their accomplishments and the person they have become.
If they feel they have led a successful life, they often feel satisfied and develop a sense of integrity.
Conversely, individuals who do not feel they have achieved their life goals often feel unsatisfied and may experience hopelessness and despair, which can lead to depression.

Ernstmeyer & Christman, 2021

Contact info: info@nursesinternational.org

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Late Adulthood: Cognitive Development

Memory:

Working memory is negatively impacted by age
Long-term memory declines
Prospective memory rapidly declines
Recall memory starts to decline at the age of 40
Changes in attention:

Older adults less able to selectively focus on information while ignoring distractors.

University of Arkansas, 2020

Contact info: info@nursesinternational.org

Working memory is composed of three major systems: The phonological loop that maintains information about auditory stimuli, the visuospatial sketchpad, which maintains information about visual stimuli, and the central executive, which oversees working memory, allocating resources where needed and monitoring whether cognitive strategies are being effective (Schwartz, 2011). The central executive is most negatively impacted by age.

Long-term memory is divided into semantic (knowledge of facts), episodic (events), and implicit (procedural skills, classical conditioning, and priming) memories. Semantic and episodic memory is part of the explicit memory system, which requires conscious effort to create and retrieve. Several studies consistently reveal that episodic memory shows greater age-related declines than semantic memory.

Prospective memory rapidly declines: remembering things we need to do in the future, such as a doctor’s appointment next week or taking medication before bedtime.

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Late Adulthood: Mental Health

One in four older adults experiences a mental health problem:

Depression
Anxiety
Schizophrenia
Dementia

The suicide rate for men over 85 is higher than that in any other age group.

American Psychological Association, 2021

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Late Adulthood: Common Health Issues

Back and neck pain
Osteoarthritis
Chronic obstructive pulmonary disease
Diabetes
Heart disease
Cancer
Major cardiovascular disease (stroke)

WHO, 2021

University of Arkansas, 2020

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Case Study/ Critical Thinking Question/ What Would the Nurse Do?

An elderly client is seen in the office for a routine physical.

He tells the nurse that his wife of 51 years passed away this month.

What risk factors should the nurse assess during this visit?

Explain the rationale for the nursing intervention.

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Late Adulthood: Social Change

Loss in capacities and a decline in functional ability.
Loss of independence.
May experience bereavement.
Drop in socioeconomic status with retirement.
These above stressors may result in:

Isolation
Loneliness
Psychological distress

WHO, 2017

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Late Adulthood: Social Change (Continued)

Vulnerable to elder abuse: (1 in 6 elders experience abuse)

Physical abuse
Verbal abuse
Psychological abuse
Financial abuse
Sexual abuse
Abandonment
Neglect
Significant loss of dignity and respect

WHO, 2017

Little, 2016

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Older Adult: Nurse Role (Assessment)

Modification of communication techniques may be required.

Consider the impact of chronic disease on their ability to function and complete Activities of Daily Living (ADLs).

Use of evidence-based tools to assess the needs of elders.

(Fulmer SPICES tool)

Ernstmeyer & Christman, 2021

Contact info: info@nursesinternational.org

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Older Adult: Nurse Role (Communication)

Start with the right body language
Exercise patience
Show respect
Active listening
Build rapport
Show sincerity
Recognize sensory challenges
Ensure comfort
Use plain language
Show empathy

Regis College, 2021

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Older Adult: Nurse Role (Assessment)

The SPICES tool includes an assessment of the following:

S: Sleep Disorders
P: Problems with Eating or Feeding
I: Incontinence
C: Confusion
E: Evidence of Falls
S: Skin Breakdown

For more information and sample:

https://hign.org/sites/default/files/2020-06/Try_This_General_Assessment_1.pdf

Ernstmeyer & Christman, 2021

Contact info: info@nursesinternational.org

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Case Study/ Critical Thinking Question/ What Would the Nurse Do?

Which of the following interventions are examples of how to communicate effectively with the older adult? (Select all that apply).

Show respect
Active listening
Show sincerity
Recognize sensory challenges
Use plain language
Show Empathy

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Older Adult: Nurse Role (Health Promotion)

Preventive care (encourage vaccines to protect against flu and pneumonia)
Advocate for health improvement

Early detection of dementia with intervention
Decrease hospitalization for urinary infections, falls, and pneumonia.
Reduce incidences of medication-related safety issues
Improve physical activity and oral health
Decrease complications of osteoporosis

Ernstmeyer & Christman, 2021

Contact info: info@nursesinternational.org

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Older Adult: Nurse Role (Health Promotion)

Areas of intervention:

Encourage high-quality nutrition
Encourage physical activity
Education for safe medication use
Promote psychosocial well being

Ernstmeyer & Christman, 2021

Contact info: info@nursesinternational.org

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Older Adult: Nurse Role (Health Promotion)

Education focus:

Healthy nutrition
Physical activity
Smoking cessation

Regular dental care
Initiate referrals to social workers or case managers for assistance with financial or health care concerns, as well as for referrals to community resources.

Ernstmeyer & Christman, 2021

Contact info: info@nursesinternational.org

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Older Adult: Physical Activity

Help individuals find appropriate ways to maintain physical activity.
Encourage regular health care checks and discuss concerns that limit activity.
Reassure the pain is not considered a normal part of aging and can be effectively treated.

Ernstmeyer & Christman, 2021

Contact info: info@nursesinternational.org

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Older Adult: Safe Medication Use

Polypharmacy

Increases risk of adverse medication effects.

Confusion

Safe management of medication.
Provides written materials for clients that complement pharmaceutical leaflets with larger print and good color contrast for clients with poor vision.

Ernstmeyer & Christman, 2021

Azhagesan, 2017

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Older Adult: Safe Medication Use

Education

Review medication with client (name, appearance, purpose, and effects).
Potential adverse effects and interactions with other medication.
Contact the healthcare provider when concerned.
Potential drug-related problems that warrant emergency care.
Importance of taking medications as directed.
Importance of using only one pharmacy.
Use of prefilled medication dispensing containers.

Azhagesan, 2017

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Evidence Based Care Strategies in Hospital

Treat the person not the disease
Monitor for signs and symptoms of clinical deterioration
Promote independence
Ensure the client is eating and drinking
Be alert for changes in cognitive and functional status
Involve family and caregivers in planning care
Screen the older person’s family or caregiver for psychosocial and emotional wellbeing issues.
Manage the elder’s pain

Victoria Department of Health, 2015

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Case Study/ Critical Thinking Question/ What Would the Nurse Do?

A client comes to the clinic for back pain and asks for medication to alleviate the pain.

What is the first thing the nurse should do?

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Red Flags

Bruises, cuts, burns, or broken bones that are unexplainable or suspiciously explained.
Malnourishment or weight loss.
Poor hygiene, an unkempt appearance, unclean clothing, or dirty, matted hair.
Foul odor from clothing or body.
Anxiety, depression, or confusion.
Unexplained financial transactions or loss of money.
Withdrawal from family members or friends.

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Applying Purnell’s Model for Cultural Competency

An elderly male patient well known to you comes to clinic. He is much quieter than usual, has lost 10 pounds, and sits far away from the son accompanying him.

Which of Purnell’s 12 Domains might apply here?
What questions would the nurse ask?
What cultural concerns might the nurse identify?

Contact info: info@nursesinternational.org

The nurse should be aware that the client is demonstrating significant changes. The nurse should assess the client and son using questions related to Purnell Model’s Domain: Family Roles and Organization. This could be done by asking: What are the roles and duties of adults in your family?Who makes most of the decisions in your family? What are priorities for your family? What do family members expect from you? As family members become older, there may be changes in their physical and psychological abilities. This may result in a cultural conflict related to changes in the family’s previous expectations of roles and organization. The nurse should be aware that these types of changes can produce significant stress. This level of stress can results in physical and/or psychological abuse of the elder person. (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7968466/) Using Purnell’s Model can guide the nurse to identify these role changes, discuss them with client and family, and begin to identify appropriate resources to help the client and family.

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Cultural Considerations

Religion, culture, beliefs, and ethnic customs can influence how families understand and use health concepts:

Health beliefs: In some cultures, talking about a possible poor health outcome will cause that outcome to occur.
Health customs: In some cultures, family members play a large role in healthcare decision-making.
Ethnic customs: Differing gender roles may determine who makes decisions about accepting and following treatment recommendations.

AHRQ, 2020

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Cultural Considerations (Continued)

Religion, culture, beliefs, and ethnic customs can influence how families understand and use health concepts:

Religious beliefs: Faith and spiritual beliefs may affect health-seeking behavior and willingness to accept treatment.
Dietary customs: Dietary advice may be difficult to follow if it does not fit the foods or cooking methods of the family.
Interpersonal customs: Eye contact or physical touch may be acceptable in some cultures but inappropriate or offensive in others.

(AHRQ, 2020)

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References

Agency for Healthcare Research. (2020). Health Literacy Universal Precautions Toolkit, 2nd Edition. https://www.ahrq.gov/health-literacy/improve/precautions/tool10.html

American Psychological Association. (2021). Older Adults. https://www.apa.org/pi/aging/resources/guides/older#:~:text=Most%20older%20adults%20report%20good,of%20any%20other%20age%20group

Azhagesan, C.(2017). Nurses Role in Polypharmacy. Nursing Healthcare and International Journal. Medwin Publisher. https://medwinpublishers.com/NHIJ/NHIJ16000123.pdf

Ernstmeyer, K., & Christman, E. (Eds.). (2021). Open RN Nursing Fundamentals by Chippewa Valley Technical College is licensed under CC BY 4.0.

Contact info: info@nursesinternational.org

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References

Little, W. 2016. Introduction to Sociology-2nd Canadian Edition under a Creative Commons Attribution 4.0 International License, except where otherwise noted. https://opentextbc.ca/introductiontosociology2ndedition

Regis College. (2021, October 31). 10 Tips for Nurses to Effectively Communicate with Elderly Patients. https://online.regiscollege.edu/blog/elderly-patient-care/

Stangor, C., & Walinga, J. (2014).Introduction to Psychology – 1st Canadian Edition licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License. https://opentextbc.ca/introductiontopsychology/

University of Arkansas. (2020). Human Behavior and the Social Environment. https://uark.pressbooks.pub/hbse1/

Contact info: info@nursesinternational.org

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References

Victoria Department of Health. (2015). Providing best care for older people. https://www.health.vic.gov.au/patient-care/providing-best-care-for-older-people

WHO. (2021). Ageing and Health. https://www.who.int/news-room/fact-sheets/detail/ageing-and-health

WHO. (2017). Mental Health of Older Adults. https://www.who.int/news-room/fact-sheets/detail/mental-health-of-older-adults

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