Preventing Functional Decline through SPICES

Mary Spear, RN-BC, MSN, GNP

Geriatric Clinical Nurse Specialist

John Muir Health – proprietary and confidential2

Objectives

Define components of SPICES

Identify Geriatric Syndromes associated with SPICES

Identify three (3) interventions to prevent functional decline

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Functional Decline Prevention

Functional ability = indicator of health

Goal:

Goal of interventions is to enable elders to function

at highest level despite the presence of age related

changes, risk factors, and disease

(Miller, C. 2012)

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• Think: FUNCTION

• Think: MAXIMIZE FUNCTION

Gawande, A. (April 30, 2007). The Way We Age Now.

The New Yorker Annals of Medicine

http://www.newyorker.com/magazine/2007/04/30/the-way-we-age-now

John Muir Health – proprietary and confidential5

Educational Resources

Hartford Institute for Geriatric Nursing

Hartfordign.org/practice/try_this/

NICHE – Nurses Improving Care of HS Elders

www.nicheprogram.org

Local universities – UC Berkeley, UCSF, Stanford

Professional Organizations

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Care of the Geriatric Patient

Complexity of care

Geriatric Syndromes Syndrome is a group of signs and/or symptoms that

occur together & characterize a

particular abnormality

Underlying all of these issues is the

presence of multiple problems and

causes rather than only one or two

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SPICES

S Skin Breakdown

P Problems with eating or feeding

I Incontinence

C Confusion

E Evidence of Falls

S Sleep Disorder

(Hartford Institute of Geriatric Nursing, 2012)

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AGE-RELATED CHANGES

SKIN – epidermis changes (thins, loss of strength and elasticity), decreased sweat glands, decreased blood flow to skin, loss of subcutaneous fat

PROBLEMS with Eating/Feeding – decreased taste buds, thirst perception, muscle strength for chewing, saliva, teeth, gag reflex, GI acid, stomach emptying, absorption in small intestine, decreased sense of smell

INCONTINENCE – reduced bladder elasticity, muscle tone, capacity, increased postvoid residual, nocturnal urine production, BPH in males, prolapse in females

John Muir Health – proprietary and confidential9

AGE-RELATED CHANGES

Confusion/Cognitive Decline – decrease in neurons, weight of brain, decline in ability to learn complex information, delayed response time, minor loss of recent memory, decline in ability to do complex tasks requiring multiple steps

Pathological conditions of cognitive impairment seen

with the older adult are:

Depression

Delirium

Dementia

John Muir Health – proprietary and confidential10

AGE-RELATED CHANGES

EVIDENCE OF FALLS – decline in muscle mass and strength, decline in size, number, quality of skeletal muscle fibers, bone loss, decreased cartilage in joints, reduced joint stability, intervetebral disc degeneration

SLEEP – normal changes in circadian patterns (sleep-wake) result in nocturnal awakenings, with increase in transient arousals, increase in time until sleep onset, decreased periods of REM sleep (restorative sleep)

(Brown, J., Bedford, N, White, S. 1999)

John Muir Health – proprietary and confidential11

Age Related Sensory Changes

Vision

Presbyopia

Cataracts

Glaucoma

Macular Degeneration

Hearing

Presbycusis

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Age Related Sensory Changes

Taste

4 basic tastes: Sweet, Salty, Sour, Bitter

Loss of taste buds

Smell

Decrease in number of sensory cells in nasal lining

Touch

Decreased sensation; safety issues

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Case Study

Pt. is a 75 y.o. female admitted after found on floor in home. She has had numerous falls, is unable to care for self, though refuses to leave her home. MM is a widow, husband died 4 yrs. Ago. She has no children nor relatives in the area.

MM has a large dog at home and states, “I like animals more than I like people.”

Issues – SPICES

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References

Brown, J., Bedford, N., White, S. (1999). Gerontological Protocol for Nurse Practitioners. Lippincott Williams & Wilkins

Miller, C. (2012). Nursing for Wellness in Older Adults, 6th Ed. Philadelphia, PA. Wolters Kluwer Health/Lippincott Williams & Wilkins