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P A R T
Older Adults and Wellness 1
C H A P T E R 1Seeing Older Adults Through the Eyes of Wellness 1
IMAGES OF AGING 1THE RELATIONSHIP BETWEEN WELLNESS AND AGING 2
Wellness and Older Adults 2Wellness and Nursing Care of Older Adults 2Definitions of Aging 3Descriptions of Successful Aging 4
ATTITUDES TOWARD AGING 5Shifting Trends 5Ageism 5Effects of Ageism 6Addressing Attitudes of Nurses 8
DEBUNKING MYTHS: UNDERSTANDING REALITIES ABOUT OLDER ADULTS IN THE UNITED STATES 8
Demographics of Aging 9Health Characteristics 11Socioeconomic Characteristics 11Living Arrangements of Older Adults 13
OLDER ADULTS IN FAMILIES 14Trends in Caregiving 14Older Adults as Recipients and Givers of Care 15Grandparents Raising Grandchildren 16
OLDER ADULTS IN THE WORLD 16
C H A P T E R 2Addressing Diversity of Older Adults 20
CULTURAL DIVERSITY IN THE UNITED STATES 20CULTURAL COMPETENCE 21
Performing a Cultural Self-Assessment 21
Obtaining Information About Culturally Diverse Groups 22
Linguistic Competence in Care of Older Adults 23CULTURAL PERSPECTIVES ON WELLNESS 23HEALTH DISPARITIES 24OVERVIEW OF CULTURAL GROUPS OF OLDERADULTS IN THE UNITED STATES 26
African Americans 26Hispanics or Latinos 27Asians and Pacific Islanders in the United States 29American Indians and Alaska Natives 30
OLDER ADULTS IN OTHER DIVERSE GROUPS 31Older Adults in Rural Areas 32Homeless Older Adults 32Lesbian, Gay, Bisexual, and
Transgender Older Adults 32
C H A P T E R 3Applying a Nursing Model for PromotingWellness in Older Adults 36
A NURSING THEORY FOR WELLNESS-FOCUSEDCARE OF OLDER ADULTS 36CONCEPTS UNDERLYING THE FUNCTIONALCONSEQUENCES THEORY 37
Functional Consequences 37Age-Related Changes and Risk Factors 39Person 40Nursing 41Health 41Environment 42
APPLYING THE THEORY TO PROMOTE WELLNESS IN OLDER ADULTS 42
C H A P T E R 4Theoretical Perspectives on Aging Well 45
HOW CAN WE LIVE LONG AND WELL? 45Life Span and Life Expectancy 46
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Rectangularization of the Curve and Compression of Morbidity 46
Active Life Expectancy 47Relationships Among Aging, Disease,
and Death 48Studies of Healthy Aging 48
HOW DO WE EXPLAIN BIOLOGIC AGING? 49Wear-and-Tear Theories 49Cross-Linkage Theory 49Free Radical Theory 49Neuroendocrine and Immunity Theories 49Genetic Theories 50Apoptosis Theory 50Caloric Restriction Theories 50Conclusions About Biologic Theories and
Relevance to Nurses 50SOCIOCULTURAL PERSPECTIVES ON AGING 51
Disengagement Theory 52Activity Theory 52Subculture and Age Stratification Theories 52Emerging Sociocultural Theories 53Person–Environment Fit Theory 53Relevance of Sociocultural Theories of
Aging to Nurses 53PSYCHOLOGICAL PERSPECTIVES ON AGING 54
Human Needs Theory 54Life-Course and Personality Development
Theories 54Theory of Gerotranscendence 55Theories About Gender and Aging 55Relevance of Psychological Theories of
Aging to Nurses 55A HOLISTIC PERSPECTIVE ON AGING AND WELLNESS 56
P A R T
Nursing Considerations for Older Adults 59
C H A P T E R 5Gerontological Nursing and Health Promotion 59
GERONTOLOGY AND GERIATRICS 59GERONTOLOGICAL NURSING 60
Gerontological Nursing Education and Practice 60Roles for Gerontological Nurses 61
Evidence-Based Practice for Gerontological Nursing 61
HEALTH, WELLNESS, AND HEALTH PROMOTION 63
Health Promotion for Older Adults 64Health Promotion Initiatives for Older Adults 64Types and Examples of Health Promotion
Interventions for Older Adults 65Promotion of Physical Activity as a Nursing
Intervention for Wellness 68THE TRANSTHEORETICAL MODEL OF HEALTHPROMOTION 69
C H A P T E R 6Diverse Health Care Settings for Older Adults 75
DEVELOPMENT OF A CONTINUUM OF CARE FOR OLDER ADULTS 75ACUTE CARE SETTINGS 77
Specialized Geriatric Acute Care Units 77Subacute Care Units 77Hospital-at-Home Model 77Transitional Care Models 78Roles for Gerontological Nurses in
Acute Care Settings 78NURSING HOME SETTINGS 78
Levels of Nursing Home Care 78Admission to Long-Term Care 79Trends in Nursing Home Care 79Roles for Gerontological Nurses in
Nursing Home Settings 80NEWER MODELS OF NURSING HOME CARE 80
The Culture Change Movement 80Evidence for Positive Outcomes With
Culture Change 81Pioneer Network 81Assisted-Living Facilities 81Roles for Nurses in Newer Models of Care 82
HOME CARE SERVICES 82Trends in Home Care Services 82Skilled Home Care 83Long-Term Home Care 83Sources of Home Care Services 83
COMMUNITY-BASED SERVICES FOR OLDER ADULTS 84
Adult Day Centers 84Respite Services 85Parish Nursing Programs 85Health Promotion Programs 85
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Roles for Gerontological Nurses in Home andCommunity Settings 85
MODELS ADDRESSING COORDINATION OF CARE 86
Comprehensive Models 86Chronic Care Models 87Care and Case Management Services 87
PAYING FOR HEALTH CARE SERVICES FOR OLDER ADULTS 88
Out-of-Pocket Expenses 88Medicare 88Medigap Insurance 88Medicaid 89Older Americans Act 90Long-Term Care Insurance 90
C H A P T E R 7Assessment of Health and Functioning 94
ASSESS ING HEALTH OF OLDER ADULTS 94NURSING ASSESSMENT TOOLS 95ASSESSING FUNCTION OF OLDER ADULTS 95
Using Functional Assessment Tools 95Assessing Activities of Daily Living 99Assessing Instrumental Activities of Daily
Living 101Assessing Function in Cognitively Impaired
Older Adults 101Assessing the Use or Potential Use of Adaptive
and Assistive Devices 105COMPREHENSIVE GERIATRIC ASSESSMENTS 106ASSESSING OLDER ADULTS IN RELATION TO THEIRENVIRONMENTS 106ASSESSING AND ADDRESSING DRIVING SAFETY 108
Identifying Risks and Consequences 108Addressing Risk Factors 109Referring to Community Resources 109Working With Caregivers 110
C H A P T E R 8Medications and Other Bioactive Substances 113
INTRODUCTION TO BIOACTIVE SUBSTANCES 113Considerations Regarding Medications 113Considerations Regarding Herbs and
Homeopathy 115
AGE-RELATED CHANGES THAT AFFECT BIOACTIVESUBSTANCES IN OLDER ADULTS 118
Changes That Affect the Action of BioactiveSubstances in the Body 118
Changes That Affect Behaviors Related to Taking Bioactive Substances 120
RISK FACTORS THAT AFFECT BIOACTIVESUBSTANCES 120
Pathologic Processes and Functional Impairments 121
Behaviors Based on Myths and Misunderstandings 121
Communication Barriers 122Lack of Information 122Inappropriate Prescribing Practices 122Polypharmacy and Inadequate Monitoring of
Medications 124Medication Nonadherence 124Financial Concerns Related to Prescription
Drugs 124Insufficient Recognition of Adverse Medication
Effects 125MEDICATION INTERACTIONS 125
Medication–Medication Interactions 125Medications and Herbs 126Medications and Nutrients 127Medications and Alcohol 128Medications and Caffeine 128Medications and Nicotine 128
FUNCTIONAL CONSEQUENCES ASSOCIATED WITH BIOACTIVE SUBSTANCES IN OLDER ADULTS 129
Altered Therapeutic Effects 129Increased Potential for Adverse Effects 129Anticholinergic Adverse Effects 130Altered Mental Status 130Tardive Dyskinesia and Drug-Induced
Parkinsonism 131Antipsychotics in People With Dementia 131
NURSING ASSESSMENT OF MEDICATION USE AND EFFECTS 131
Communication Techniques for Obtaining Accurate Information 132
Scope of a Medication Assessment 132Observing Patterns of Medication Use 134Linking the Medication Assessment to the
Overall Assessment 135Identifying Adverse Medication Effects 135
NURSING DIAGNOSIS 136
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PLANNING FOR WELLNESS OUTCOMES 136NURSING INTERVENTIONS TO PROMOTE HEALTHYMEDICATION-TAKING PATTERNS 136
Implementing Evidence-Based Interventions 136Teaching About Medications 137Teaching About Herbs and Other Bioactive
Substances 138Addressing Factors That Affect Adherence 139Decreasing the Number of Medications 141
EVALUATING EFFECTIVENESS OF NURSINGINTERVENTIONS 142
C H A P T E R 9Legal and Ethical Concerns 149
AUTONOMY AND RIGHTS 149Competency 150Decision-Making Capacity 150
ADVANCE DIRECTIVES 151Living Wills and Do Not Resuscitate (DNR) Orders 152Durable Power of Attorney for Health Care 152
LEGAL ISSUES SPECIFIC TO LONG-TERM CARESETTINGS 153ETHICAL ISSUES COMMONLY ADDRESSED INGERONTOLOGICAL NURSING 153
Ethical Issues in Everyday Care of Older Adults 153Ethical Issues Specific to Long-Term
Care Settings 154Ethical Issues Related to Artificial Nutrition and
Hydration 154CULTURAL ASPECTS OF LEGAL AND ETHICAL ISSUES 155ROLE OF NURSES REGARDING LEGAL AND ETHICAL ISSUES 156
Implementing Advance Directives 156Facilitating Decisions About Care 158
C H A P T E R 10Elder Abuse and Neglect 162
OVERVIEW OF ELDER ABUSE AND NEGLECT 162Characteristics of Elder Abuse 162Historical Recognition of a Social Problem 163Prevalence and Causes 163Cultural Considerations 164
RISK FACTORS FOR ELDER ABUSE AND NEGLECT 165
Invisibility and Vulnerability 165Psychosocial Factors 165Caregiver Factors 165
ELDER ABUSE AND NEGLECT IN NURSING HOMES 166FUNCTIONAL CONSEQUENCES ASSOCIATED WITHELDER ABUSE AND NEGLECT 167NURSING ASSESSMENT OF ABUSED ORNEGLECTED OLDER ADULTS 168
Unique Aspects of Elder Abuse Assessment 168Physical Health 169Activities of Daily Living 171Psychosocial Function 171Support Resources 172Environmental Influences 172Threats to Life 173Cultural Aspects 173
NURSING DIAGNOSIS 174PLANNING FOR WELLNESS OUTCOMES 175NURSING INTERVENTIONS TO ADDRESS ELDER ABUSE AND NEGLECT 175
Interventions in Institutional Settings 175Interventions in Community Settings 176Interventions in Multidisciplinary Teams 176Referrals 177Prevention and Treatment Interventions 177
LEGAL INTERVENTIONS 178Adult Protective Services 179Ethical Issues 181
EVALUATING EFFECTIVENESS OF NURSINGINTERVENTIONS 182
P A R T
Promoting Wellness in PsychosocialFunction 187
C H A P T E R 11Cognitive Function 187
AGE-RELATED CHANGES THAT AFFECT COGNITION 187
Central Nervous System 188Fluid and Crystallized Intelligence 189Memory 189Adult Psychological Development 190
RISK FACTORS THAT AFFECT COGNITIVE WELLNESS 191
Personal, Social, and Attitudinal Influences 191Physical and Mental Health Factors 192
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Medication Effects 192Smoking and Environmental Factors 192
FUNCTIONAL CONSEQUENCES AFFECTINGCOGNITIVE FUNCTION 193NURSING ASSESSMENT OF COGNITIVE FUNCTION 193NURSING DIAGNOSIS 194PLANNING FOR WELLNESS OUTCOMES 194NURSING INTERVENTIONS TO PROMOTECOGNITIVE WELLNESS 194
Teaching About Memory and Cognition 195Improving Concentration and Attention 195Encouraging Participation in Mentally Stimulating
Activities 195Adapting Health Education Materials 197
EVALUATING EFFECTIVENESS OF NURSING INTERVENTIONS 198
C H A P T E R 1 2Psychosocial Function 202
LIFE EVENTS: AGE-RELATED CHANGES AFFECTING PSYCHOSOCIAL FUNCTION 202
Retirement 203Relocation 204Chronic Illness and Functional Impairments 204Decisions About Driving a Vehicle 204Widowhood 205Death of Friends and Family 205Ageist Attitudes 205
THEORIES ABOUT PSYCHOSOCIAL FUNCTION INOLDER ADULTS 206
Theories About Emotional Development DuringLater Adulthood 206
Theories About Stress 206Theories About Coping 207
FACTORS THAT INFLUENCE PSYCHOSOCIALFUNCTION IN OLDER ADULTS 208
Religion and Spirituality 208Cultural Considerations 209
RISK FACTORS THAT AFFECT PSYCHOSOCIALFUNCTION 211FUNCTIONAL CONSEQUENCES ASSOCIATED WITHPSYCHOSOCIAL FUNCTION IN OLDER ADULTS 212NURSING ASSESSMENT OF PSYCHOSOCIALFUNCTION 212NURSING DIAGNOSIS 212PLANNING FOR WELLNESS OUTCOMES 213
NURSING INTERVENTIONS TO PROMOTE HEALTHYPSYCHOSOCIAL FUNCTION 213
Enhancing Self-Esteem 214Promoting a Sense of Control 215Involving Older Adults in Decision Making 215Addressing Role Loss 216Encouraging Life Review and Reminiscence 216Fostering Social Supports 217Addressing Spiritual Needs 217Promoting Wellness Through Healthy
Aging Classes 218EVALUATING THE EFFECTIVENESS OF NURSINGINTERVENTIONS 221
C H A P T E R 13Psychosocial Assessment 226
OVERVIEW OF PSYCHOSOCIAL ASSESSMENT OF OLDER ADULTS 226
Purposes of the Psychosocial Assessment Process 227
Procedure for the Psychosocial Assessment 227Scope of the Psychosocial Assessment 228
COMMUNICATION SKILLS FOR PSYCHOSOCIAL ASSESSMENT 229
Identifying Communication Barriers 229Enhancing Communication With Older Adults 230Creating an Environment That Supports Good
Communication 231MENTAL STATUS ASSESSMENT 233
Physical Appearance 234Motor Function and Psychomotor Behaviors 234Social Skills 235Response to the Interview 235Orientation 235Alertness and Attention 236Memory 236Speech and Language Characteristics 237Higher Language Skills 238
DECISION-MAKING AND EXECUTIVE FUNCTION 238AFFECTIVE FUNCTION 240
Guidelines for Assessing Affective Function 240Mood 241Anxiety 241Self-Esteem 242Depression 243Happiness and Well-Being 243
CONTACT WITH REALITY 244Delusions 244Hallucinations and Illusions 247
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Special Considerations for Assessing Contact WithReality in Older Adults 249
SOCIAL SUPPORTS 249Social Network 250Barriers to Obtaining Social Supports 251Economic Resources 251
RELIGION AND SPIRITUALITY 251
C H A P T E R 14Impaired Cognitive Function: Deliriumand Dementia 255
DELIRIUM 255Overview and Types 255Prevalence, Risk Factors, and Functional
Consequences of Delirium 256Nursing Assessment of Delirium 256Nursing Diagnosis and Outcomes 257Nursing Interventions for Delirium 257
OVERVIEW OF DEMENTIA 259Terminology to Describe Dementia 259Theories to Explain Dementia 259Diagnosing Dementia 260
TYPES OF DEMENTIA 260Alzheimer’s Disease 261Vascular Dementia 263Lewy Body Dementia 264Frontotemporal Dementia 264
FACTORS ASSOCIATED WITH DEMENTIA 264FUNCTIONAL CONSEQUENCES ASSOCIATED WITH DEMENTIA IN OLDER ADULTS 265
Stages of Dementia 265Self-awareness of People With Dementia 266Personal Experiences of Dementia 266Behavioral and Psychological Symptoms of
Dementia 268NURSING ASSESSMENT OF DEMENTIA IN OLDERADULTS 269
Factors That Interfere With the Assessment ofDementia 269
Initial Assessment 269Ongoing Assessment of Consequences 269
NURSING DIAGNOSIS 270PLANNING FOR WELLNESS OUTCOMES 271NURSING INTERVENTIONS TO ADDRESS DEMENTIA 271
Promoting Wellness for People With Dementia 273Theoretical Frameworks for Nursing
Interventions 273
General Principles of Nursing Interventions inDifferent Settings 273
Improving Safety and Function ThroughEnvironmental Modifications 275
Communicating With Older Adults With Dementia 276
Teaching About Pharmacologic Interventions 276EVALUATING THE EFFECTIVENESS OF NURSING INTERVENTIONS 279
C H A P T E R 15Impaired Affective Function: Depression 287
THEORIES ABOUT LATE-LIFE DEPRESSION 287Psychosocial Theories 287Cognitive Triad Theory 289Biologic and Genetic Theories 289Theories About Depression and Dementia 289
CLASSIFICATION OF DEPRESSION 290RISK FACTORS FOR DEPRESSION IN OLDER ADULTS 290
Demographic Factors and Psychosocial Influences 290Medical Conditions and Functional
Impairments 291Effects of Medications and Alcohol 292
FUNCTIONAL CONSEQUENCES ASSOCIATED WITH DEPRESSION IN OLDER ADULTS 292
Physical Health and Functioning 292Psychosocial Function and Quality of Life 293
NURSING ASSESSMENT OF DEPRESSION IN OLDER ADULTS 294
Identifying the Unique Manifestations of Depression 294
Using Screening Tools 295NURSING DIAGNOSIS 296PLANNING FOR WELLNESS OUTCOMES 296NURSING INTERVENTIONS TO ADDRESS DEPRESSION 296
Alleviating Risk Factors 297Improving Psychosocial Function 297Promoting Health Through Physical
Activity and Nutrition 297Providing Education and Counseling 298Facilitating Referrals for Psychosocial Therapies 299Teaching About and Managing Antidepressant
Medications 299Teaching About Electroconvulsive Therapy 301Teaching About Complementary and
Alternative Interventions 302
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EVALUATING THE EFFECTIVENESS OF NURSINGINTERVENTIONS 302SUICIDE 302
Assessing the Risks for Suicide 303Nursing Diagnosis and Outcomes 305Nursing Interventions for Preventing Suicide 305Evaluating the Effectiveness of Nursing
Interventions 305
P A R T
Promoting Wellness in PhysicalFunction 311
C H A P T E R 16Hearing 311
AGE-RELATED CHANGES THAT AFFECT HEARING 311
External Ear 311Middle Ear 312Inner Ear 313Auditory Nervous System 314
RISK FACTORS THAT AFFECT HEARING WELLNESS 314
Lifestyle and Environmental Factors 314Impacted Cerumen 315Medication Effects 315Disease Processes 316
FUNCTIONAL CONSEQUENCES AFFECTINGHEARING WELLNESS 316
Effects on Communication 316Effects of Hearing Loss on Overall Wellness 317
PATHOLOGIC CONDITION AFFECTING HEARING: TINNITUS 318NURSING ASSESSMENT OF HEARING 318
Interviewing About Hearing Changes 318Observing Behavioral Cues 320Using Hearing Assessment Tools 320
NURSING DIAGNOSIS 321PLANNING FOR WELLNESS OUTCOMES 322NURSING INTERVENTIONS FOR HEARINGWELLNESS 322
Promoting Hearing Wellness for All Older Adults 322
Preventing and Alleviating Impacted Cerumen 323Compensating for Hearing Deficits 323
Communicating With Hearing-Impaired Older Adults 328
EVALUATING EFFECTIVENESS OF NURSINGINTERVENTIONS 329
C H A P T E R 17Vision 333AGE-RELATED CHANGES THAT AFFECT VISION 333
Eye Appearance and Tear Ducts 333The Eye 335The Retinal–Neural Pathway 336
EFFECTS OF AGE-RELATED CHANGES ON VISION 336Loss of Accommodation 337Diminished Acuity 337Delayed Dark and Light Adaptation 337Increased Glare Sensitivity 337Reduced Visual Field 337Diminished Depth Perception 337Altered Color Vision 338Diminished Critical Flicker Fusion 338Slower Visual Information Processing 338
RISK FACTORS THAT AFFECT VISUAL WELLNESS 338FUNCTIONAL CONSEQUENCES AFFECTING VISUALWELLNESS 339
Effects on Safety and Function 339Effects on Quality of Life 340Effects on Driving 340
PATHOLOGIC CONDITIONS AFFECTING VISION 341Cataracts 341Age-Related Macular Degeneration 343Glaucoma 343
NURSING ASSESSMENT OF VISION 345Interviewing About Vision Changes 345Identifying Opportunities for Health Promotion 345Observing Cues to Visual Function 346Using Standard Vision Tests 347
NURSING DIAGNOSIS 348PLANNING FOR WELLNESS OUTCOMES 348NURSING INTERVENTIONS FOR VISUAL WELLNESS 348
Health Promotion for Visual Wellness 348Comfort Measures for Dry Eyes 350Environmental Modifications 350Low-Vision Aids 350Maintaining and Improving the Quality of Life 351
EVALUATING EFFECTIVENESS OF NURSINGINTERVENTIONS 353
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C H A P T E R 18Digestion and Nutrition 358
AGE-RELATED CHANGES THAT AFFECT DIGESTION AND EATING PATTERNS 358
Smell and Taste 358Oral Cavity 359Esophagus and Stomach 360Intestinal Tract 360Liver, Pancreas, and Gallbladder 360
AGE-RELATED CHANGES IN NUTRITIONALREQUIREMENTS 360
Calories 361Protein 361Carbohydrates and Fiber 361Fats 361Water 361
RISK FACTORS THAT AFFECT DIGESTION AND NUTRITION 362
Conditions Related to Oral Care 363Functional Impairments and Disease Processes 363Medication Effects 364Lifestyle Factors 364Psychosocial Factors 365Cultural and Socioeconomic Factors 365Environmental Factors 366Behaviors Based on Myths and
Misunderstandings 367FUNCTIONAL CONSEQUENCES AFFECTINGDIGESTION AND NUTRITION 367
Ability to Procure, Prepare, and Enjoy Food 367Changes in Oral Function 367Nutritional Status and Weight Changes 368Quality of Life 368
PATHOLOGIC CONDITIONS AFFECTING DIGESTIVE WELLNESS: CONSTIPATION 369NURSING ASSESSMENT OF DIGESTION AND NUTRITION 369
Interviewing About Digestion and Nutrition 369Observing Cues to Digestion and Nutrition 370Using Physical Assessment and Laboratory
Information 370Using Assessment Tools 371
NURSING DIAGNOSIS 372PLANNING FOR WELLNESS OUTCOMES 374NURSING INTERVENTIONS TO PROMOTE HEALTHY DIGESTION AND NUTRITION 374
Addressing Risk Factors That Interfere WithDigestion and Nutrition 374
Promoting Oral and Dental Health 375
Promoting Optimal Nutrition and Preventing Disease 376
EVALUATING EFFECTIVENESS OF NURSINGINTERVENTIONS 377
C H A P T E R 19Urinary Function 383
AGE-RELATED CHANGES THAT AFFECT URINARY WELLNESS 383
Changes in the Kidneys 383Changes in the Bladder and Urinary Tract 385Changes in Control Mechanisms 385Changes Affecting Control Over Socially
Appropriate Urinary Elimination 386RISK FACTORS THAT AFFECT URINARY WELLNESS 386
Behaviors Based on Myths and Misunderstandings 386
Functional Impairments 387Pathologic Conditions 387Medication Effects 388Environmental Factors 388
FUNCTIONAL CONSEQUENCES AFFECTINGURINARY WELLNESS 389
Effects on Homeostasis 389Effects on Voiding Patterns 389
PATHOLOGIC CONDITION AFFECTING URINARYFUNCTION: URINARY INCONTINENCE 390NURSING ASSESSMENT OF URINARY FUNCTION 391
Talking With Older Adults About Urinary Function 391
Identifying Opportunities for Health Promotion 392Using Laboratory Information 393
NURSING DIAGNOSIS 395PLANNING FOR WELLNESS OUTCOMES 395NURSING INTERVENTIONS TO PROMOTE HEALTHY URINARY FUNCTION 395
Teaching About Urinary Wellness 395Promoting Continence and Alleviating
Incontinence 396Managing Incontinence 401
EVALUATING EFFECTIVENESS OF NURSING INTERVENTIONS 402
C H A P T E R 20Cardiovascular Function 408
AGE-RELATED CHANGES THAT AFFECTCARDIOVASCULAR FUNCTION 408
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Myocardium and Neuroconduction Mechanisms 409
Vasculature 410Baroreflex Mechanisms 410
RISK FACTORS THAT AFFECT CARDIOVASCULAR FUNCTION 410
Atherosclerosis 411Physical Inactivity 411Tobacco Smoking 412Dietary Habits 412Obesity 412Hypertension 412Lipid Disorders 413Metabolic Syndrome 414Psychosocial Factors 414Heredity and Socioeconomic Factors 415Risk for Cardiovascular Disease in Women
and Minority Groups 415FUNCTIONAL CONSEQUENCES AFFECTINGCARDIOVASCULAR WELLNESS 416
Effects on Cardiac Function 416Effects on Pulse and Blood Pressure 416Effects on the Response to Exercise 416Effects on Circulation 416
PATHOLOGIC CONDITIONS AFFECTINGCARDIOVASCULAR WELLNESS: ORTHOSTATIC AND POSTPRANDIAL HYPOTENSION 417NURSING ASSESSMENT OF CARDIOVASCULARFUNCTION 417
Assessing Baseline Cardiovascular Function 418Assessing Blood Pressure 418Identifying Risks for Cardiovascular Disease 418Assessing Signs and Symptoms of Heart Disease 419Assessing Knowledge About Heart Disease 422
NURSING DIAGNOSIS 422PLANNING FOR WELLNESS OUTCOMES 423NURSING INTERVENTIONS TO PROMOTE HEALTHYCARDIOVASCULAR FUNCTION 423
Addressing Risks Through Nutrition and LifestyleInterventions 423
Secondary Prevention 424Addressing Risks Through Pharmacologic
Interventions 425Preventing and Managing Hypertension 425Preventing and Managing Lipid Disorders 428Preventing and Managing Orthostatic or
Postprandial Hypotension 429EVALUATING EFFECTIVENESS OF NURSINGINTERVENTIONS 429
C H A P T E R 21Respiratory Function 435
AGE-RELATED CHANGES THAT AFFECTRESPIRATORY FUNCTION 435
Upper Respiratory Structures 435Chest Wall and Musculoskeletal Structures 436Lung Structure and Function 437
RISK FACTORS THAT AFFECT RESPIRATORYWELLNESS 438
Tobacco Use 438Secondhand Smoke and Other Environmental
Factors 439Additional Risk Factors for Compromised
Respiratory Function 439FUNCTIONAL CONSEQUENCES AFFECTINGRESPIRATORY WELLNESS 440PATHOLOGIC CONDITION AFFECTINGRESPIRATORY FUNCTION: COPD 441NURSING ASSESSMENT OF RESPIRATORYFUNCTION 441
Identifying Opportunities for Health Promotion 441
Detecting Lower Respiratory Infections 442Assessing Smoking Behaviors 443Identifying Other Risk Factors 444Physical Assessment Findings 444
NURSING DIAGNOSIS 445PLANNING FOR WELLNESS OUTCOMES 445NURSING INTERVENTIONS FOR RESPIRATORYWELLNESS 445
Promoting Respiratory Wellness 445Preventing Lower Respiratory Infections 446Eliminating the Risk From Smoking 447
EVALUATING EFFECTIVENESS OF NURSINGINTERVENTIONS 448
C H A P T E R 22Mobility and Safety 452
AGE-RELATED CHANGES THAT AFFECT MOBILITY AND SAFETY 452
Bones 452Muscles 453Joints and Connective Tissue 454Nervous System 454Osteopenia and Osteoporosis 454
RISK FACTORS THAT AFFECT MOBILITY AND SAFETY 454
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Risk Factors That Affect Overall MusculoskeletalFunction 455
Risk Factors for Osteoporosis and OsteoporoticFractures 455
Risk Factors for Falls 456PATHOLOGIC CONDITION AFFECTINGMUSCULOSKELETAL FUNCTION: OSTEOARTHRITIS 458FUNCTIONAL CONSEQUENCES AFFECTINGMUSCULOSKELETAL WELLNESS 459
Effects on Musculoskeletal Function 459Susceptibility to Falls and Fractures 459Fear of Falling 460
NURSING ASSESSMENT OF MUSCULOSKELETALFUNCTION 460
Assessing Musculoskeletal Performance 460Identifying Risks for Osteoporosis 461Identifying Risks for Falls and Injury 462
NURSING DIAGNOSIS 464PLANNING FOR WELLNESS OUTCOMES 464NURSING INTERVENTIONS FORMUSCULOSKELETAL WELLNESS 464
Promoting Healthy Musculoskeletal Function andPreventing Falls 464
Health Education About Osteoporosis 465Preventing Falls and Fall-Related Injuries 467
EVALUATING EFFECTIVENESS OF NURSINGINTERVENTIONS 471
C H A P T E R 23Integument 477
AGE-RELATED CHANGES THAT AFFECT THE SKIN 477
Epidermis 477Dermis 479Subcutaneous Tissue and Cutaneous Nerves 479Sweat and Sebaceous Glands 479Nails 479Hair 479
RISK FACTORS THAT AFFECT SKIN WELLNESS 480Genetic Influences 480Lifestyle and Environmental Influences 480Medication Effects 480
FUNCTIONAL CONSEQUENCES AFFECTING SKIN WELLNESS 481
Susceptibility to Injury 481Response to Ultraviolet Radiation 481Comfort and Sensation 481Cosmetic Effects 481
PATHOLOGIC CONDITIONS AFFECTING SKIN: SKINCANCER AND PRESSURE ULCERS 482
Skin Cancer 482Pressure Ulcers 483
NURSING ASSESSMENT OF SKIN 487Identifying Opportunities for Health Promotion 487Observing Skin, Hair, and Nails 487
NURSING DIAGNOSIS 490PLANNING FOR WELLNESS OUTCOMES 490NURSING INTERVENTIONS FOR SKIN WELLNESS 491
Promoting Healthy Skin 491Preventing Skin Wrinkles 491Preventing Dry Skin 492Detecting and Treating Harmful Skin Lesions 492
EVALUATING EFFECTIVENESS OF NURSINGINTERVENTIONS 492
C H A P T E R 24Sleep and Rest 496
AGE-RELATED CHANGES THAT AFFECT SLEEP AND REST PATTERNS 496
Sleep Quantity 497Sleep Quality 498Circadian Rhythm 498
RISK FACTORS THAT CAN AFFECT SLEEP 499Psychosocial Factors 499Environmental Factors 499Pathophysiologic Factors 500Effects of Bioactive Substances 500
FUNCTIONAL CONSEQUENCES AFFECTING SLEEP WELLNESS 501PATHOLOGIC CONDITION AFFECTING SLEEP:OBSTRUCTIVE SLEEP APNEA 502NURSING ASSESSMENT OF SLEEP 503
Identifying Opportunities for Health Promotion 503Evidence-Based Assessment Tools 503
NURSING DIAGNOSIS 504PLANNING FOR WELLNESS OUTCOMES 504NURSING INTERVENTIONS FOR SLEEP WELLNESS 504
Evidence-Based Interventions 504Self-Care Actions to Promote Healthy
Sleep Patterns 505Complementary and Alternative Care
Practices 505Improving Sleep for Older Adults in
Institutional Settings 506
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Modifying the Environment to Promote Sleep 507Educating Older Adults About Medications
and Sleep 507Teaching About Management of Sleep
Disorders 507EVALUATING EFFECTIVENESS OF NURSING INTERVENTIONS 509
C H A P T E R 25Thermoregulation 513
AGE-RELATED CHANGES THAT AFFECTTHERMOREGULATION 513
Response to Cold Temperatures 513Response to Hot Temperatures 515Normal Body Temperature and Febrile
Response to Illness 515RISK FACTORS THAT AFFECT THERMOREGULATION 515
Pathophysiologic Conditions That AlterThermoregulation 515
Environmental and Socioeconomic Influences 515Behaviors Based on Lack of Knowledge 516
FUNCTIONAL CONSEQUENCES ASSOCIATED WITHTHERMOREGULATION IN OLDER ADULTS 516
Altered Response to Cold Environments 517Altered Response to Hot Environments 517Altered Thermoregulatory Response to Illness 517Altered Perception of Environmental
Temperatures 517Psychosocial Consequences of Altered
Thermoregulation 517NURSING ASSESSMENT OF THERMOREGULATION 518
Assessing Baseline Temperature 518Identifying Risk Factors for Altered
Thermoregulation 518Assessing for Hypothermia 519Assessing for Hyperthermia 519Assessing the Older Adult’s Febrile
Response to Illness 520NURSING DIAGNOSIS 520PLANNING FOR WELLNESS OUTCOMES 520NURSING INTERVENTIONS TO PROMOTE HEALTHYTHERMOREGULATION 520
Addressing Risk Factors 520Promoting Healthy Thermoregulation 521
EVALUATING EFFECTIVENESS OF NURSING INTERVENTIONS 521
C H A P T E R 26Sexual Function 525
AGE-RELATED CHANGES THAT AFFECT SEXUAL FUNCTION 525
Changes Affecting Older Women 525Changes Affecting Older Men 527
RISK FACTORS THAT AFFECT SEXUAL FUNCTION 527
Societal Influences 527Attitudes and Behaviors of Families and
Caregivers 528Limited Opportunities for Sexual Activity 528Adverse Effects of Medication, Alcohol,
and Nicotine 529Chronic Conditions 529Gender-Specific Conditions 530Functional Impairments and Dementia 530
FUNCTIONAL CONSEQUENCES AFFECTINGSEXUAL WELLNESS 530
Reproductive Ability 531Response to Sexual Stimulation 531Sexual Interest and Activity 531Male Sexual Dysfunction 532Female Sexual Dysfunction 532
PATHOLOGIC CONDITION AFFECTING SEXUAL WELLNESS: HUMAN IMMUNODEFICIENCY VIRUS 533
Risk Factors for HIV 533Role of Nurses in Assessment and
Interventions 534NURSING ASSESSMENT OF SEXUAL FUNCTION 534
Self-Assessment of Attitudes About Sexual Function and Aging 534
Assessing Sexual Function in Older Adults 535NURSING DIAGNOSIS 537PLANNING FOR WELLNESS OUTCOMES 537NURSING INTERVENTIONS TO PROMOTE HEALTHY SEXUAL FUNCTION 537
Teaching Older Adults About Sexual Wellness 537
Addressing Risk Factors 537Promoting Sexual Wellness in Long-Term Care
Settings 539Teaching Women About Interventions 539Teaching Men About Interventions 540
EVALUATING EFFECTIVENESS OF NURSINGINTERVENTIONS 541
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P A R T
Promoting Wellness in All Stages of Health and Illness 547
C H A P T E R 27Caring for Older Adults During Illness 547
CHARACTERISTICS OF ILLNESS IN OLDER ADULTS 547CONNECTING THE CONCEPTS OF WELLNESS, AGING, AND ILLNESS 548HOLISTICALLY CARING FOR OLDER ADULTS WHO ARE ILL: FOCUSING ON CARING AND COMFORTING 549APPLYING WELLNESS CONCEPTS IN SPECIFICPATHOLOGIC OR CHRONIC CONDITIONS 550
Promoting Wellness for Older Adults With Cancer 550
Promoting Wellness for Older Adults With Diabetes Mellitus 552
Promoting Wellness for Older Adults With Heart Failure 553
ADDRESSING NEEDS OF FAMILIES ANDCAREGIVERS 555
C H A P T E R 28Caring for Older Adults Experiencing Pain 560
ACUTE VERSUS PERSISTENT PAIN 560ANATOMY AND PHYSIOLOGY OF PAIN 561TYPES OF PAIN 562CAUSES OF PAIN IN OLDER ADULTS 562AGE-RELATED CHANGES THAT AFFECT PAIN 563BARRIERS TO PAIN MANAGEMENT 563FUNCTIONAL CONSEQUENCES OF PAIN IN OLDER ADULTS 563
CULTURAL ASPECTS OF PAIN ASSESSMENT AND MANAGEMENT 563NURSING ASSESSMENT OF PAIN IN OLDER ADULTS 565
Collecting Pertinent Information 565Assessment of Pain Components 566Assessment in Cognitively Impaired Older
Adults 568PRINCIPLES OF ANALGESIC MEDICATION 568
Classifications of Analgesics 569The World Health Organization’s Three-Step
Pain Relief Ladder for Pain Management 570Management of Side Effects and Risks of
Tolerance, Dependence, and Addiction 571Developing a Wellness-Focused Pain
Management Plan 571
C H A P T E R 29Caring for Older Adults at the End of Life 575
THE DYING PROCESS AND DEATH 575NURSING SKILLS FOR PALLIATIVE CARE 576PERSPECTIVES ON DEATH AND DYING 576
Sites of Death and Dying 576Views of Death and Dying in Western Culture 576Older Adults’ Perspective on Death and
Dying 577Health Care Professionals’ Perspective on
Death and Dying 577Culturally Diverse Perspectives on Death and
Dying 578QUALITY OF CARE AT THE END OF LIFE 578
Promoting Wellness at the End of Life 579Hospice Care 580
NURSING INTERVENTIONS IN END-OF-LIFE CARE 581
Promoting Communication 581Offering Spiritual Support 581Managing Symptoms 582
INDEX 589
5
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