Ru for Older Adult Common Prob

8/3/2019 Ru for Older Adult Common Prob

1/8


2/8

3. Identify risk factors

for falls in the elderly

4. Assess the factors thatcauses falls in the

elderly

hospitalization he may experience loss of self esteem or a

feeling of falling again, of being unable to perform hisADLS or of social rejection which in turn can lead to

depression and withdrawal. The most common fracturesare of the vertebrae, hip, forearm, leg, ankle, pelvis,

upper arm and hand.

Risk Factors

Risk factors for falls can be categorized into intrinsic and

extrinsic factors. Intrinsic risk factors relate to thechanges associated with aging and with disorders of

physical functions needed to maintain balance. Extrinsicrisk factors are related to environmental hazards and

challenges such as poor lighting, stairs, clutter, and throw

rugs.

Fall Assessment

A number of fall assessment tools are available to assess

inpatient risk of falls, but no single tool has been adopteduniversally. Most tools contain a fall history, an

examination of mental and mobility status, a checklist forthe presence of sensory deficits, a list of medications the

client is receiving, and a list of primary and secondarydiagnoses.

Interventions/ Strategies for Fall Prevention

1. Modify the environment


3/8

5. Develop a plan to

prevent falls andinjuries utilizing

nonrestraint

interventions

Orientation to the environment with an emphasis

on safety devices is the first step in preventingfalls. Other strategies include non-skid slippers or

shoes, hip protectors, removal of obstacles andclutter, having the commode close to the bed,

having the call light within easy access, and

encouraging use of glasses and hearing aids.

2. Evaluate gait and balanceAssess muscle strength and ability frequently andinstitute appropriate measures for safe mobility

and transfer techniques.

3. Review medicationsDuring an inpatient admission is a good time to

thoroughly review all the medications the patientis on for desired effect, adverse effect,interactions, and the older persons

knowledgebase of the medications they aretaking.

4. Develop a fall prevention planTinniti found that risk of falling increased with

the number of disabilities, but that modifying justa few factors may reduce the risk.

5. Restraint useRestrictive procedures were designed to reduce oreliminate maladaptive or unsafe behaviours. A

physical restraint is any physical or mechanical

device that involuntarily restrains a patient as ameans of controlling physical activity. A chemicalrestraint refers to the use of a


4/8


5/8

fluctuating severity of symptoms that include

restlessness, irritability, sleep disturbance, fatigue, andimpaired concentration. Panic attacks are characterized

by an autonomic arousal that includes tachycardia,difficulty breathing, diaphoresis, light-headedness,

trembling, and severe weakness.

Assessment

Nursing assessment should include risk identification,medical evaluation, and careful attention to the clients

verbalization of thoughts and feelings. Anxiety can be the

most prominent presenting symptom in depression, andthis comorbid psychosis is very common in the elderly.

Interventions/Strategies for Care

Nursing interventions in the acute care setting includeinstructions prior to painful procedures and in self-

management of pain. Many interventions for pain, suchas relaxation, breathing techniques, distraction, and

cognitive restructuring, can simultaneously decreaseanxiety.

DEPRESSION


6/8

Prevalence

Although depression is the most common mental health

disorder in older adults, it is not a normal consequence ofaging. Role changes, major life events, and comorbid

illnesses all contribute to an increased rate depression in

the geriatric population.

Implications/Relevance of Depression

depression is linked to a decreased quality of life in the

older adult, through loss of interest, motivation,creativity, and ability to plan. Depressed individuals

perceive medical illnesses as having a greater impact oneveryday life and have twice the health care costs of

nondepressed adults with similar illnesses.

Depression, Dementia, and Delirium

Depression in the older adult can often be difficult to

recognize. Dementia, delirium, medication side effects,and situational grief response can complicate the

diagnosis of depression. The essential features fordelirium include (1) disturbance of consciousness; (2)

change in cognition such as memory deficit, languagedisturbance, or the development of disorientation; and (3)

that these changes are of recent onset and fluctuate duringthe course of the day. In detecting and managing delirium

follow the mnemonic ADVISE:

A= Advocacy- In these state patient cannot speak for themselves


7/8

and misdiagnoses are often made unless those

closest to the patients advocate for themV= Vigilance

- Once the treatment for delirium begins, thepractitioner needs to be very watchful of the

patient, monitoring the response to treatment

I= Integration

- Use all the resources available to care for thepatient. This means using appropriate

pharmacology

S= Support- Support systems of the older adult

E= education- Once the delirium resolves, carefully educate both

the patient and the family as to the probable cause

and how to avoid it in the future.

Dementia, a group of symptoms accompanying disease,

manifests as memory loss; disorientation; changes inmood or personality; and difficulties in abstract thinking,

task performance, and language use. The most commonform of dementia is Alzheimers disease.

The American Psychiatric Association defines depression

as a disorder that includes changes in feelings or mood,described as feeling sad, hopeless, pessimistic, or blue

lasting most of the day, with loss of interest in

pleasurable activities.

Assessment


8/8

The Cornell Scale for Depression in Dementia (CSDD) isa reliable and valid instrument for assessing depression in

older adults who also have dementia. Proper diagnosisand treatment of depression rely on the practitioners

ability to determine underlying medical conditions or

medication side effects contributing to or causing thedepression.

Interventions/Strategies for Care

Treatment of depression in the older adult is aimedtoward remission and prevention of recurrence. Early

recognition of risk and appropriate therapy can increaseboth the quality and quantity of life in the depressed older

client. Pharmacological therapy, including tricyclicantidepressants (TCAs) and SSRIs, requires close

monitoring because of the increased risk of adverse

effects in the older individual.

Cognitive-behavioral therapy (CBT) has the greatest

research support among psychosocial interventions fordepression. This therapy focuses on increasing the

awareness of the relationship among thoughts,behaviours, and physiological responses.

Nursing interventions that can improve depression

include exercise, light therapy, alternative medicine, andcounselling.

Documents

Ru for Older Adult Common Prob