👨‍⚕️Nursing Care of Vulnerable Populations Unit 9 – Caring for Elderly & Aging Populations

Key Concepts in Elderly Care

• Holistic approach considers the physical, psychological, social, and spiritual needs of older adults
• Person-centered care focuses on individual preferences, values, and goals in care planning and delivery
• Multidisciplinary teams collaborate to provide comprehensive care, including nurses, physicians, therapists, and social workers
• Age-related changes impact various body systems, requiring adaptations in care delivery
• Functional status assessment evaluates an older adult's ability to perform activities of daily living (ADLs) and instrumental activities of daily living (IADLs)
  • ADLs include basic self-care tasks (bathing, dressing, toileting, and eating)
  • IADLs involve more complex tasks (managing finances, preparing meals, and using transportation)
• Polypharmacy, the use of multiple medications, is common among older adults and increases the risk of adverse drug events
• Health promotion and disease prevention strategies, such as regular exercise and immunizations, help maintain older adults' well-being

Age-Related Changes and Health Challenges

• Sensory changes, including vision and hearing loss, can impact communication and safety
• Cardiovascular changes, such as decreased heart function and stiffening of blood vessels, increase the risk of hypertension and heart disease
• Respiratory changes, including decreased lung capacity and elasticity, may lead to increased susceptibility to infections and chronic conditions (COPD)
• Musculoskeletal changes, such as decreased bone density and muscle mass, contribute to increased risk of falls and fractures
• Cognitive changes, including memory loss and slowed processing speed, may be part of normal aging or indicative of conditions (dementia)
• Urinary system changes, such as decreased bladder capacity and weakened pelvic floor muscles, can lead to incontinence
• Immune system changes result in increased susceptibility to infections and slower wound healing
• Skin changes, including thinning and decreased elasticity, increase the risk of pressure ulcers and skin tears

Common Geriatric Conditions

• Dementia, including Alzheimer's disease, affects memory, thinking, and behavior
  • Stages of dementia progress from mild cognitive impairment to severe cognitive decline
  • Non-pharmacological interventions, such as reminiscence therapy and environmental modifications, can help manage symptoms
• Osteoporosis, characterized by decreased bone density, increases the risk of fractures
• Arthritis, including osteoarthritis and rheumatoid arthritis, causes joint pain and stiffness
• Cardiovascular diseases, such as hypertension, coronary artery disease, and heart failure, are prevalent among older adults
• Diabetes mellitus requires careful management to prevent complications (neuropathy, retinopathy, and nephropathy)
• Depression is common among older adults and may be underdiagnosed and undertreated
• Urinary incontinence can be caused by various factors, including weakened pelvic floor muscles, urinary tract infections, and certain medications

Assessment Techniques for Older Adults

• Comprehensive geriatric assessment (CGA) evaluates an older adult's medical, functional, cognitive, and psychosocial status
  • Components of CGA include medical history, physical examination, functional assessment, and cognitive screening
• Functional assessment tools, such as the Katz Index of Independence in Activities of Daily Living and the Lawton Instrumental Activities of Daily Living Scale, evaluate an older adult's ability to perform ADLs and IADLs
• Cognitive assessment tools, including the Mini-Mental State Examination (MMSE) and the Montreal Cognitive Assessment (MoCA), screen for cognitive impairment
• Nutritional assessment, using tools like the Mini Nutritional Assessment (MNA), identifies older adults at risk for malnutrition
• Fall risk assessment, using tools such as the Morse Fall Scale or the Timed Up and Go (TUG) test, helps identify individuals at high risk for falls
• Pain assessment, using scales like the Numeric Rating Scale (NRS) or the Faces Pain Scale, helps evaluate and manage pain in older adults
• Skin assessment, using tools like the Braden Scale, helps identify individuals at risk for pressure ulcers

Medication Management in the Elderly

• Polypharmacy increases the risk of adverse drug events, drug interactions, and medication non-adherence
• Age-related changes in pharmacokinetics and pharmacodynamics alter drug absorption, distribution, metabolism, and excretion
• Medication reconciliation involves reviewing and updating an individual's medication list to ensure accuracy and prevent errors
• Deprescribing is the process of discontinuing or reducing the dose of medications that may no longer be necessary or may cause harm
• Medication adherence can be improved through strategies (pill organizers, reminder systems, and patient education)
• Monitoring for adverse drug reactions and interactions is crucial, especially when introducing new medications or changing dosages
• Collaboration with pharmacists and other healthcare professionals can help optimize medication management for older adults

Promoting Independence and Quality of Life

• Encouraging physical activity and exercise helps maintain mobility, strength, and balance
• Providing assistive devices, such as walkers, canes, and grab bars, can enhance safety and independence
• Modifying the home environment, including removing tripping hazards and improving lighting, can reduce the risk of falls
• Promoting social engagement and participation in meaningful activities can help prevent isolation and depression
• Supporting self-care and self-management empowers older adults to take an active role in their health and well-being
• Addressing sensory impairments, such as providing hearing aids or visual aids, can improve communication and overall quality of life
• Incorporating person-centered care principles ensures that an individual's preferences, values, and goals are respected and integrated into care planning

Ethical Considerations in Geriatric Care

• Autonomy refers to an individual's right to make decisions about their own care and treatment
• Informed consent involves providing clear, understandable information about treatment options, risks, and benefits to enable decision-making
• Capacity assessment evaluates an individual's ability to understand information and make decisions
• Advance directives, including living wills and healthcare power of attorney, allow individuals to express their preferences for care in the event of incapacity
• End-of-life care planning involves discussing and documenting an individual's wishes for care near the end of life
• Balancing beneficence (promoting well-being) and non-maleficence (avoiding harm) is essential in making treatment decisions
• Addressing elder abuse and neglect involves recognizing signs, reporting suspected cases, and ensuring a safe environment

Support Systems and Resources for Aging Populations

• Family caregivers play a crucial role in providing care and support to older adults
  • Caregiver education and training can help improve care quality and reduce caregiver burden
  • Respite care services provide temporary relief for caregivers, allowing them to rest and recharge
• Community-based services, such as adult day care, meal delivery, and transportation services, can help older adults remain in their homes
• Long-term care options, including assisted living facilities and nursing homes, provide varying levels of care and support for older adults
• Palliative care focuses on improving quality of life and managing symptoms for individuals with serious illnesses
• Hospice care provides compassionate end-of-life care, emphasizing comfort and support for individuals and their families
• Government programs, such as Medicare and Medicaid, provide health insurance coverage and financial assistance for eligible older adults
• Local Area Agencies on Aging (AAAs) offer information, referrals, and services to support older adults and their caregivers in the community