Angelite Nurses

Aging is a normal developmental process that occurs throughout the life span, causing a progressive decrease in functional capabilities. The elderly client is generally regarded as one who is 65 years of age or older.

Biologic Theories of Aging

1. Immunity theory
1. Primary organs of the immune system (bone marrow and thymus) are affected by the aging process, causing decreased numbers of T cells and a decline in humoral cell mediated responses.
2. Increase in the incidence of infections, autoimmunity, and cancer with aging.
2. Crosslinkage theory
1. Crosslinking is a chemical reaction that produces irreparable, spontaneous damage to DNA and results in cell death.
2. Crosslinking over a lifetime causes interference with normal cell functioning and impedes intracellular transport.
3. Irreversible aging of proteins such as collagen is responsible for ultimate failure of tissues and organs--especially lungs, heart, muscle, and lining of vessel walls.
3. Free radical theory
1. Free radicals oxidatively attack adjacent molecules.
2. Chemical and structural changes are progressive.
3. Free radicals do not contain useful biographical information and replace genetic order with randomness, causing faulty molecules as person ages.
4. Stress theory
1. Old age is determined by the amount of wear and tear to which one has been exposed, not chronological age.
2. Currently stress theory is receiving little support from aging theorists.
5. Error theory
1. Cell nucleus emits inappropriate information that interferes with normal cell functioning and causes cell mutations.
2. Mutated cells are less able to perform normal functions and organs become inefficient and senescent.
3. Cellular mutations are thought to result from extracellular influences such as radiation.
6. Biological programming
1. Senescence occurs at the cellular level.
2. Cellular reproduction is a programmed event under genetic control.

Physical Changes of Aging
See Table 4.10


Table 4.10 Physical Changes of Aging

Psychosocial Changes in the Elderly

1. Aging process is not just physical; psychologic, social, and cultural factors play a crucial role.
1. Some cultures revere the elderly.
2. American culture places a high value on youth.
2. Developmental tasks of the elderly
1. Ego integrity vs despair (Erikson)
1. Ego integrity results when the individual accepts own life as having been meaningful and appropriate.
2. Despair results from the lack of ego integration and the feeling that time is too short to start another life and to find new means toward integrity.
2. Other developmental tasks
1. Successfully adjusting to retirement
2. Making satisfactory living arrangements
3. Adjusting to reduced income
4. Keeping socially active
5. Maintaining contact with friends and family members
6. Adjusting to death of spouse
7. Viewing own death as an appropriate outcome of life

Psychologic/Social Theories of Aging

1. Activity theory
1. The relationship between society and the aging individual remains fairly stable as the person passes from middle age to old age.
2. If roles are relinquished (e.g., retirement from job) the person will substitute new roles.
2. Developmental or continuity theory
1. As a person grows older, he or she is likely to maintain continuity in habits, preferences, commitments, etc., that are a part of personality.
2. Because these factors are very complex and individualized, this theory implies that there are many possible adaptations to aging.
3. Disengagement theory
1. Aging is an inevitable mutual withdrawal or disengagement of the aging person and society from each other.
2. The number of interrelationships with others is reduced, those remaining are altered in quality.

PLANNING AND IMPLEMENTATION

Goals

1. Maximum independence in self-care activities will be maintained.
2. Client will maintain normal bowel and bladder elimination patterns.
3. Client will maintain ability to communicate.
4. Client will maintain positive self-concept.
5. Client will remain free from injury.
6. Optimal cognitive functioning will be maintained.
7. Skin integrity will be maintained.
8. Client will maintain adequate nutritional status and fluid balance.
9. Client will maintain social contacts.
10. Client will follow treatment regimens as prescribed.

Interventions


Pharmacotherapy in the Elderly

1. General information
1. Decreased body weight, dehydration, and slowed organ functioning may cause higher concentrations of drugs in tissues and slower excretion of drugs, resulting in a greater likelihood of accumulation of overdosage than in a younger person.
2. The elderly often have multiple chronic diseases, which may affect metabolism and excretion of drugs.
3. Rate of medication errors among the elderly estimated to be between 25 to 50% for those living in the community.
4. Elderly often take several drugs and may have more than one physician prescribing drugs, increasing risk of drug-drug interaction.
2. Nursing care
1. Perform a drug inventory with client; determine all prescription and over-the-counter drugs the client is taking.
2. Assess client's perceptions of purpose of drug therapy.
3. Assess client's ability to administer medications safely; vision, reading ability, memory, judgment, motivation, and fine motor coordination.
4. Provide aids if indicated; large-print instructions, memory aids, daily drug dose containers, premeasured syringes, unit dose, etc.
5. Be alert for the possibility of drug-drug interactions. Check with pharmacist if in doubt.
6. Determine baseline measures of vital signs, mental status, bladder and bowel function, and vision before starting drug therapy.
7. Common drug-induced pathology includes confusion, falls, incontinence, and immobility.
8. Determine if client needs assistance to pay for prescriptions.
9. Teach family proper techniques for administering oral medication. Client should be positioned with head forward and neck slightly flexed to facilitate swallowing. Head back with neck hyperextended puts client at risk for difficulty swallowing and aspiration.
10. Liquid rather than tablet forms of drugs may be indicated for clients who have difficulty swallowing medication.
11. Monitor client for effectiveness of medications and for adverse reactions.
12. Teach family members about client's medication regime if indicated.

EVALUATION

1. Client performs self-care activities; if client is unable to perform these, caregiver provides needed assistance.
2. Client is continent of feces and urine; voids in adequate amounts and has regular bowel elimination.
3. Client is able to communicate needs and concerns.
4. Client makes positive statements about self.
5. Client/caregiver modifies environment as needed to provide safety.
6. Client is alert and oriented.
7. Skin is intact with no decubiti.
8. Client eats nutritionally balanced diet and maintains stable weight.
9. Client maintains friends and social interactions.
10. Client describes and adheres to treatment regimen.

* This section on aging was contributed by Judith C. Miller, RN, MSN.

AGING

ABUSE AND NEGLECT

1. General information
1. Elder abuse is the willful infliction of physical pain, injury, or debilitating mental anguish, unreasonable confinement, or the willful deprivation by a caretaker of services that are necessary to maintain physical and mental health.
2. Elder neglect refers to an elderly person who is living alone and not able to provide for him/herself or to an elderly person who is not receiving necessary services from the responsible caretaker.
3. Abuse can be physical (i.e., beatings or withholding medical care); psychological (i.e., instilling fear through verbal assaults or isolating the elder); material (i.e., theft of money or personal belongings); or violation of rights (i.e., being forced out of one's home).
4. Problem is widespread and occurs in the home and in health care facilities.
2. Assessment findings
1. Identify individuals at risk.
1. Persons who are dependent and have a limited informal support network.
2. Persons whose primary caregivers express frustration or high stress levels.
3. Persons who come from families with a history of abuse.
4. Individuals who are substance abusers or whose family includes substance abusers.
5. Persons who have disorders that have multiple physical and emotional disabilities such as Parkinson's disease, Alzheimer's disease, and CVA.
2. Signs and symptoms may include
1. Signs of malnutrition
2. Poor hygiene and grooming
3. Omission of medication or overmedication
4. Decubiti
3. When assessing for abuse the nurse should consider:
1. Is the person in immediate danger of bodily harm?
2. Is the person competent to make decisions regarding his/her care?
3. What is the degree and significance of the person's functional impairments?
4. What specific services might help to meet the unmet needs?
5. Who in the family is involved and to what extent?
6. Are the client and family willing to accept intervention?
3. Nursing interventions
1. Report suspected abuse according to state laws.
2. Obtain client's consent for treatment.
3. Document nursing assessments of client's physical and emotional status.
4. Refer client and family to support services.
5. Remove client from setting if necessary.
6. Provide for careful follow-up as potential for further abuse is high.