An Aging Society

An Aging SocietyQUALITY CARE FOR THE GERONTOLOGICAL POPULATION

Linda HansenFerris State University

An Aging Society. Quality Care for the Gerontological Population1OBJECTIVESThe learner will :exhibit knowledge of how the aging population uses the health care system by stating two facts related to health care useidentify three anatomical and physiological changes that occur during the normal aging process state two wellness diagnoses of the aging population.identify two theories of agingidentify five assessment tools available to evaluate the aging population state 2 characteristics for optimal care of the aging population state how increased knowledge can help to prevent poor outcomes in the aging population

Read the objectives.2Population StatisticsThe Elderly population is the fastest growing population in the United States By the year 2030, 20% of the population will be over the age of sixty-five The largest population growth will be in the age group over 85

Barba, B. & Fay, V. 2009

The geriatric population is said to be the fastest growing segment of the population in many countries around the world. In the United States, statistics show this also to be true with the numbers increasing especially in the population over 85. This graph shows that the peak percentage of the aging population will occur in this decade. The dilemma we are faced with is not only Will there be enough nurses to care for this aging population but will they be adequately trained?3

This graph shows the growth of the elderly population in numbers. By the year 2030 there will be approximately 70 million elderly compared to about 40 million in the year 2010.4Health Care Service Statistics10.5 visits per year compared to 6.4 visits85% of all home cares 90% of ECF population Use 48% of nations top health resources60% of hospital admissions

Barba, B. & Fay, V. 2009

The elderly population average 10.5 visits per year to a health care provider while those under 65 average 6.4 visits. 85% of home care visits are for those patients over the age of 65, and this age group also accounts for 90% of those patients in an extended care facility. 60% of hospital admissions (excluding obstetrics) are for those older than 65. It is also noted that this age group uses 48% of the nations resources for their health care needs. This includes longer length of stays than younger counterparts for the same surgery. Complications occur more frequently as this population will also have more chronic health conditions such as heart disease, arthritis, and high blood pressure. Longer lengths of stay can also occur because this population reacts differently to medications, infections, and even some procedures.5HEALTH CHANGES IN THE ELDERLY POPULATION

It is important for health care professionals to understand physiological changes that take place in the elderly population to provide better care and improve patient outcomes. In the next few slides, I will present a little information on the health changes in this age group.6Physical and Anatomical ChangesCardiovascular changesArterial wall thickeningHeart valve damage

Smith, C. and Cotter, V. 2008

One cardiovascular change that occurs is arterial wall thickening what many people refer to as hardening of the arteries. During exercise, this population can have symptoms of fatigue or shortness of breath. Heart valve damage can also occur which can cause arrhythmias and syncope which carries its own risk of falls and injuries. Other changes can occur because of the effects of high cholesterol and hypertension.7

Physical and Anatomical Changes Continued

Musculoskeletal changesMobility impairmentDecreased muscle mass replaced with fatRisk of falls

Smith, C. and Cotter, V. 2008

Musculoskeletal changes include decreased muscle mass which in turn leads to poor exercise tolerance and then to an increased risk of falls. Osteoporosis is a concern for both men and women and dietary precautions must be taken. Functional status must be addressed in all patients that we serve to determine their ability to perform self care. 8 ArthritisPhysical and Anatomical Changes Continued

Arthritis is a common ailment of many elderly people. Many joints can be affected as exhibited above. These changes can impact functional status. Many elders consider their functional abilities more important than any disease process that may exist and it is an important consideration in the assessment of this population according to Kresevic (2008).

9Pulmonary system changesDrier mucous membranesDecreased cough reflex or weakened coughDecreased chest muscle strength Smith, C. and Cotter, V. 2008Physical and Anatomical Changes Continued

With pulmonary changes, mucous membranes are drier, and the person may have a less forceful cough. Poor cough can lead to an increased risk of pneumonia especially following a prolonged hospitalization or a surgery. Decreased exercise tolerance can occur because of shortness of breath. Years of smoking may have an impact for some.10Physical and Anatomical Changes ContinuedRenal and genito-urinary system changesDecreased bladder elasticityProstate enlargementDecreased creatinine clearancenight time voids

Smith, C. and Cotter, V. (2008)

Many complications can result from changes in the renal and genitourinary systems including decreased bladder elasticity, decreased creatinine clearance, prostate enlargement with males, UTIs, and complications for other disease processes including CHF. Due to increased night time voids, this population is at risk for falls and poor sleep. Some drugs clear slower due to the decreased creatinine clearance and can lead to toxicity. Being aware of kidney function in the older adult is imperative when administering drugs. With surgical procedures, kidney function can also be affected and it is important to closely monitor for impairment. If incontinence is occurring, skin condition will need to be closely monitored.11Physical and Anatomical Changes ContinuedOropharyngeal and GI system changesDecreased gastric motility Decreased absorption

Smith, C. and Cotter, V. (2008)

In Oropharyngeal and GI systems, taste buds can change in the elderly leading to poor nutrition. Other changes can include decreased gastric motility, decreased absorption of food and drugs. The elderly population is at an increased risk for GERD, constipation and incontinence of stool. However, Constipation and fecal incontinence are not normal findings and should be investigated. 12Physical and Anatomical Changes continuedNervous system and cognition changesDecreased sensitivity to temperatureNervous system diseasesSlower response timesSensory changes

Smith, C. and Cotter, V. (2008)

Changes also occur in the nervous system the skin can be a significant area as decreased sensitivity to temperature can occur. The elderly population must be careful when using heat or cold packs as well as during weather exposure as sensation changes. Some nervous system disorders are parkinsons disease and alzheimers disease. Changes in cognition also occur and can be exhibited as forgetfulness. Reflexes are slower and can impact some activities of daily living. Driving may be impaired and lead to loss of license. Sensory changes also occur and they will be discussed in the nest few slides.13Sensory ChangesTouhy states, sensory organs are our windows on the world.

Two sensory organs that impact the elderly are vision and hearing.

(Ebersole, Hess, Touhy, Jett, and Luggen, 2008, p. 338).

As we age, our senses change also. Taste and smell diminish which can have an impact on nutrition. Hearing and vision also changes. When a person can not hear or see well and the caregiver is unaware, a person can be determined to be cognitively impaired when they actually have a sensory deficit so it is important to investigate the cause. Sleep disturbances can become a problem for some older adults. Caution must be taken in the use of sleep aides.14Hearing LossThe two major types of hearing loss Conductive (abnormalities of the ear)Sensor-neural (presbycusis) related to aging Factors that affect hearing lossgenetics noise exposuremedical conditions medications stress

Ebersole et al., 2008

Persons with hearing loss tend to talk louder than normal, begin responding inappropriately in conversations or other social situations due to the inability to hear all of what is being said. They do not know what they are missing out on. Some may respond with irritation or inappropriate anger. Some even develop paranoia because they assume others are talking about them. The use of hearing aides can be helpful but the process can be long and involved. It is also expensive and funds may not be available.15Visual ChangesPathological changes in the eyecan lead to poorer vision, even blindnessdecreased visual acuitydecreased color discriminationcan take longer to adapt to changes in light and darknessincreased sensitivity to glarelonger time to focus

Boyce , 2003

Visual changes can impact quality of life, situations such as no longer being able to drive, setting up medications, or even drawing up or injecting meds such as insulin can be a challenge. Glasses can be helpful and a vision assessment is beneficial in determining need. Improved lighting can have an impact on poor vision and a home assessment could be helpful to determine safety needs. 16

Wellness Nursing DiagnosesAdapting to retirementAdjustment to physiological changesParticipating in satisfying activitiesDeveloping a pattern for daily lifeSatisfaction with past and present life as lived

Stolte, K. 1996

Some wellness nursing diagnoses include those listed. We see older adults in a variety of settings as patients including the hospital but also in social situations such as church or family events.. When one first retires, there is an adjustment period of exploring leisure activities and adjustment to a new lifestyle. Physiological changes are taking place and one must adjust to these changes with realization of limitations and accommodating for the changes in their environment. This also includes making health care appointments as needed and being responsible for ones own health issues. Staying healthy and active includes remaining involved in activities that are important, maintaining a semblance of structure to daily schedules. Adjustments must be made at each stage or level of aging 17