Health Care of Older Adults

Health Care of Older Adults

• Some facts about the elderly – – Currently about 13% of the population – 50% to 80% of hospitalized individuals (med/surg)

are > 65 years of age– 75% of malignancies are diagnosed in individuals

who are > 75 years of age– The fastest growing group of elderly individuals

are those between 85 and 95 years of age (the “old-old”)

(Ignatavisius & Workman, 2010)


• Why is it important for healthcare providers to be aware of the specific health needs of elderly adults?

• What are some of the common health issues faced by elderly adults? (metabolism slower, polypharmacy, brain cells atrophy, risk for falls, bleeds that go unnoticed)

• What is the role of the nurse in providing care to older adults? (book does a good job of talking about that)


• Late adulthood is divided into four distinct groups. Of these, the “old, old” is the fastest growing – 65 to 74 years of age: the young old– 75 to 84 years of age: the middle old– 85 to 99 years of age: the old-old (a/k/a

“the frail elderly”) – 100 years of age or more: the elite old

(Ignatavicius & Workman, 2010)


• Health issues faced by elderly individuals include:– Health promotion - Elderly neglect/abuse– Self-management - Mobility– Nutritional awareness– Accidents - Stress management– Drug use and misuse– Mental health/behavioral health issues


Health Care of Older Adults : Health Promotion

• Health promotion:– Needed to ensure optimal level of health– Risk factors that negate “successful” aging• alcohol abuse• smoking• depression• lack of exercise and obesity.

– Individuals at greater risk for health problems:• minorities (Ignatavicius & Workman, 2010)

• uneducated


• Chronic conditions are a significant contributor to ill-health in the elderly population (stroke, heart disease, diabetes, COPD)

• What are some of the chronic illnesses?• How might these conditions have a different

and/or greater impact on elderly individuals as compared to other people? (think of how the different systems of the body are slowed down… actual anatomy changes/slows)

Health Care of Older Adults: Health Promotion

• Education – Flu shot – Pneumococcal vaccination– Tetanus immunization (booster at 10 years)– Seat belts– Alcohol in moderation / Smoking – No– Hazard-free environment – Meds only as prescribed / Avoid OTC meds– One aspirin daily (between 81 & 325 mg) Why?


• Yearly physical examination (more often if needed)

• Reduce intake of fat to 30% of calories; saturated fat less should be < 10% of total calories (Examples of saturated fats?)

• Increase fiber-containing foods (Examples?) (Ignatavicius & Workman, 2010)


• Increase calcium intake (Why?)• Exercise 3-5 times a week for 30 minutes each

time (weight bearing, walking, doing weights)

• Coping • Socialization • Talk about your life… (a lot of them are

lonely… just want to talk) (Ignatavicius & Workman, 2010)


Health Care of Older Adults: Self Management

• Elderly individuals experience losses that may include– Death of a spouse and significant others– Loss of social networks (homebound, friends dye)– Decrease in mobility – Reduced sense of control– Sense of increasing years

• What is the role of the nurse assess cog. Ability, coping mechanisms, abililty to do ADLs, what is their normal social

network? (Ignatavicius & Workman, 2010)

Health Care of Older Adults: Nutrition

• Elderly individuals are at risk for under-nutrition

• Older individuals require increased intake of calcium, vitamins A, C and D (Why?)

• Because…– Aging interrupts the body’s capacity for storing,

using, and absorbing these nutrients– What else? (Ignatavicius & Workman, 2010)

Health Care of Older Adults: Physical Mobility

• Exercise has been shown to aid in– Decreasing falls– Increasing strength– Reducing arthritis pain– Reducing depression– Improving longevity– Reducing risks for diabetes and coronary artery

disease (Ignatavicius & Workman, 2010)

Health Care of Older Adults: Stress Management

• Maintaining and establishing relationships• Close, stable relationships (having someone to

confide in) helps to increase ability to response more positively to stress

Less favorable response to stress!

Health Care of Older Adults: Environmental

• Changes in vision, touch and mobility contribute to problems in adjusting to a new environment

• At home, safeguards should be in place (Describe)

• “Fallophobia”• “Polypharmacy” (Ignatavicius & Workman, 2006)

Health Care of Older Adults: Drug Use

• Physiologic changes in elderly individuals equate to changes in the ability to absorb, distribute, metabolize and excrete the drug

• Drug metabolism most often occurs in the liver– Age related changes: decrease in liver size;

decrease in liver blood flow; decrease in liver enzyme activity = increased plasma concentration of a drug (Ignatavicius & Workman, 2010)

Health Care of Older Adults: Drug use

• Excretion of drugs most often involves the renal system– Age related changes include decrease in renal

blood flow and reduced glomerular filtration rate – result in decreased creatinine clearance and slower excretion time for drugs – thus, serum drug levels can be toxic, and the individual may become ill or die


Health Care of Older Adults: Common Adverse Drug Reactions

• Edema * Dizziness• Nausea and vomiting * Diarrhea• Dry mouth * Constipation • Anorexia * Urinary retention• Fatigue * Confusion • Weakness (Ignatavicius & Workman, 2010)

Health Care of the Older Adult: Depression

• Most common mental health/behavioral disorder affecting elderly individuals

• Thought to be the result of a lack of the neurotransmitters norepinephrine and serotonin in the brain

• Often under-diagnosed (Ignatavicius & Workman, 2010)

Health Care and the Older Adult:Depression

• Depression (untreated) may result in– Worsening of a medical condition– Risk of physical illness– Alcoholism – Increased pain and disability– Delayed recovery from illness– Suicide (esp. elderly men) (Older adults have the

highest suicide rate among any age-group) (Ignatavicius & Workman, 2010)

Health Care of the Older Adult:Dementia

• Dementia is a broad term used to describe encompassing impairment of intellectual function

• Chronic and progressive • Most common type: Alzheimer’s disease• Multi-infarct dementia – 2nd most common


Health Care of the Older Adult:Delirium

• “Acute stage of confusion”• Often seen in older adults who are in unfamiliar

surroundings • Two types: hyperactivity (most common) and

hypoactivity (less common)• Differs from dementia – Is short term– Is reversible (usually within 3 weeks)


Health Care of the Older Adult:Delirium (Causes)

• Medications • Metabolic disturbances• Infections• Surgical operations • Circulatory, renal, and pulmonary disorders• Nutritional deficiencies • Major loss (Ignatavicius & Workman, 2010)

Health Care of the Older Adult: Neglect and Abuse

• Verbal and physical• Abuser most often a family member• Caregiver role strain • Four most common types of abuse– Neglect– Physical abuse– Financial abuse– Emotional abuse


Health of the Older Adult:Neglect and Abuse

• Neglect– Caregiver does not provide for the elderly

person’s basic needs or ADLs– Intentional or non-intentional– Neglect occurs in half of all cases of elder abuse

• Physical abuse– Results in bodily injury, esp. the “bathing suit”

area (Ignatavicius & Workman,

2010)

Health Care of the Older Adult:Neglect and Abuse

• Financial abuse– Property or other resources is mismanaged or

misused– More common than physical abuse

• Emotional abuse – Intentional use of threats, humiliation,

intimidation and isolation toward elderly individuals

– Accounts for one-third of all elder abuse

Health Care of the Older Adult: Neglect and Abuse

Every state requires (by law) that healthcare providers report suspected elder abuse

Documents

Health Care of Older Adults