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79 Cards in this Set
- Front
- Back
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Life expectancy |
71.5 for males 78 for females |
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Ageism |
Form of prejudice where older people are stereotyped by the characteristics found in only a few members of these groups (they are not all confused, incontinent, etc.). Believed that elderly have outlived their usefulness. |
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Division of elderly age |
young old - 60-74 mid old - 75-84 old old - 85+ |
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Top reason for hospital admit for elderly |
Adverse drug reaction because they are taking many RX's |
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How do elderly age? |
They live the same as middle life and adjust gradually with limitations. Ageing is not the same (synonym) as disease or disability. |
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What happens to the brain as we grow old? |
The brain atrophies (shrinks) so conditions like bleeding or swelling will have delayed signs and symptoms due to increased space. |
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Elderly and their organs |
Organs decline with age and become less efficient leading to chronic illnesses
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Cardiovascular diseases common in elderly |
Atherosclerosis & coronary heart disease because plaque builds up and elasticity decreases. High BP |
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Skeletal diseases common in elderly |
osteoporosis & arthritis |
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Skin diseases common in elderly |
basal cell carcinoma (skin cancer) |
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Theories of how & why ageing occur |
-genetic -wear & tear -free radical *none are universally agreed upon |
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Genetic theory |
States that the lifespan depends on genetic factors. Genes control the genetic clocks. |
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Wear & Tear theory |
States that organism wears out from increased metabolic function so cells become exhausted -Ex. a car as it ages will decline with function |
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Free Radical Theory |
-free radicals predispose people to cancer |
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What detoxifies or prevents formation of free radicals? |
Antioxidants. Elderly need to take them as a supplement to prevent cancer -vitamin E & C -colorful fruit -OJ if not diabetic -spinach |
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Stress in the elderly |
-Stress impairs learning and memory (tend to forget things) and releases cortisone. -immune system is depressed |
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Alzheimer's disease |
-the loss of neuron that cause short term memory loss |
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How does high cortisone levels affect the elderly? |
higher cortisone levels lead to cognitive impairment because they decrease the hypocampus size, which is responsible for memory & emotion. The higher the cortisone level, the greater the decrease in short term memory & cognitive loss |
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Most common skin problem in the elderly? |
Scaly, itchy skin from decreases oil glands. If this occurs, give less daily bathing so you do not dry them out |
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What happens when elderly have decreased oil glands? |
They will have scaly, itchy skins -complete bed bath will be needed approx. every 3-4 days instead of daily -Partial bath includes face, axilla, & perineal area -Regular soap can be used but not all the time. Can use mild or super fatted soap. |
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Why do wrinkles occur in the elderly? |
fat tissue atrophy leading to slow recoil of skin turgor |
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When sensory nerve receptors are less acute, what is required. |
A stronger stimuli to to evoke a response |
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What sensory nerve receptors in the skin are generally impacted? |
heat, cold, pressure and pain receptors, but pain is least impaired |
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What happens when there is a decrease in subcut. fat? |
-Skin appears thin -Eye look sunken in -There will be decrease in insulation so pt will get cold easily |
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Why do you have to monitor medications with elderly pt? |
Easily can reach toxic levels because the body's inability to excrete the entire dose prior to the next dose. (toxic effect) |
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What happens when elderly have decreased sweat glands? |
They are not able to tolerate heat |
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What can change in skin appearance int he elderly? |
-They can have dark spots called liver spots. -They will have skin tags -Light skinned you can see Keratosis (per-malignant cell) -Nails grow thicker and more slowly |
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How does a decrease in hormones affect the elderly? |
-In males, decreased testosterone aids in the hair loss in axillary and public area -In females, decreased estrogen allows testosterone to dominate and then increase so females can grow facial hair |
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Why does grey hair occur? |
changes in melanin production |
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What is Purpura? |
Purple-colored spots and patches that occur on the skin. Occurs when small blood vessels leak blood under the skin. When purpura spots are less than 4 mm in diameter, they are called petechiae. Purpura spots larger than 1 cm (centimeter) are called ecchymoses. -Can be a med side effect, low vitamin c or weak vessel walls. |
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What is Arcus Senilis? |
white, grey, or blue opaque ring in the cornea caused by lipids in the iris. Common in elderly. |
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Why would the conjunctiva turn yellow in the elderly? |
abnormal lipid metabolism |
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What is presbyopia? |
Far-sightedness. Elderly cannot see up close. -younger people suffer from myopia (near-sightedness) -Also cannot see at night |
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What are cataracts? |
Clouding of the lends. By 80 years old, everyone has it. |
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What is the term yellowing? |
Inability to identify the color green or blue. Everything they see if green. |
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What is otosclerosis? |
Atrophy of stapes in middle ear. Abnormal growth of bone near the middle ear. It can result in hearing loss because sound cannot travel to the inner ear. |
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What is presbycusis? |
Loss of hearing that gradually occurs in most individuals as they grow older. It is a progressive and irreversible bilateral symmetrical age-related. -sensory neuron impairment and thickening of ear drum -greater loss in left ear |
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What the the first sounds elderly lose? |
high pitched (have to lower voice to speak to elderly) |
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What happens to teeth in the elderly? |
-enamel wears away showing yellowing of dentin -cracks from hot and cold |
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Why does taste decline? |
Drop in number of taste buds. There is a decline in o'faction (smell). Unable to identify salty, sour or bitter tastes. |
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Elderly's mouth will be.... |
-dry from less salivation -may have halitosis (bad breathe from bacteria) - avoid strong mouth washes. -difficulty swallowing |
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What happens to elderly respiratory system? |
-loss of elasticity of aveoli sacs (can inflat easily but cannot recoil) - shallow, frequent breaths (same as COPD) -aveolar membrane thickens so less O2 can diffuse -cannot cough or deep breathe as well due to weakened muscles. |
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Why are elderly more prone to arrhythmias? |
myocardium has increase interstitial fibrous and increased fatty deposits. -decreased cardiac output (decrease by 1% every year after 30). -contractions are weaker and take longer |
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What happens to arteries and capillaries in elderly? |
-arteries become elongated. Walls become calcified and less elastic. Plaque builds up. -Capillaries decrease in number and become abnormally shaped -Cerebral blood flow and glucose utilization is lowered. |
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What happens to the muscleskeletal system in elderly? |
-muscle fibers are reduced -loss of muscle tissues causes osteoporosis due to demineralization of bone. Bone releases calcium and are easily fractured.Calcium uptake decreased and bone becomes soft. Breakdown exceeds replacement = osteopenia occurs. This causes the bone to be soft and fragile. -lose height - spine is collapsing and compressed fractures -Kyphosis - change in spine affects lungs and thorax -Arthritis makes them lose ability for ROM |
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How can you prevent fractures in elderly? |
-Promote exercise to to prevent/prolong this -Give calcium with Vitamin D after meals (for optimal absorption) to prevent osteoporosis. |
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What happens to the neurological system in elderly? |
lose 7% of brain mass by age 80 causing: -lessen reaction time -lessen sensation to heat, cold, and pain -lessen short term memory, retain long term memory because it is NOT sensitive to hypoxia There will be sudden confusion - often a result of a problem not age |
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What happens to the compensatory mechanism in elderly? |
-lack of temp regulation - can have pneumonia and not have a fever -lack of pain - can have appendicitis and not have pain. Can have MI and not have chest pain. -delayed wound healing -declines immune function - more susceptible to infections |
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What happens to temp regulation in elderly? |
-body temp is lowered due to decreased metabolic rate -morning temp can be 95 degrees -99.5 can represent a fever |
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What happens to the GI system in elderly? |
-decrease in salvation & gastric fluid will lead to difficulty swallowing and decreased nutrient absorption -decreased muscle tone leads to constipation and incomplete bowel evacuation -decrease sensory perception so they may miss the urge to defecate leading to constipation -loss of teeth cause change in diet |
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What is diverticular disease? |
a person has problems from small pouches, or sacs, that have formed and pushed outward through weak spots in the colon wall. Each pouch is called a diverticulum. Multiple pouches are called diverticula. -occurs in sigmoid colon -causes GI bleeds and diarrhea -Common in elderly |
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How can you prevent GI issues in elderly? |
-Cup of apple sauce (start by diluting with water) -Cup of wheat bran -3/4 cup of prune juice *discontinue if diarrhea occurs |
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What happens to the kidneys in elderly? |
-Kidneys decrease in size (tissue, loop of Henley and renal tubules shrink). Reduces number of nephrons so there will be less glomerular filtration of blood = less urine -BUN increases but creatinine may not increase due to loss in muscle tone. Creatinine clearance reduced by reduced glomerular filtration. -urine incontinence (decrease muscle tone in muscle floor). |
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Why are elderly susceptible to drug toxicity? |
-membrane of bowman's capsule of kidneys thicken and reduced glomerular filtration |
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Renal glucose in elderly |
Elderly can by hyperglycemia without being glycosuric -high blood sugar but no sugar present in the urine because less filtration. Kidneys will hold on to sugar. |
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What happens to the bladder in elderly? |
-decreased bladder capacity. Less than 200cc can cause urge to void = increased frequency). Can have overactive bladder and uncontrolled urges and frequent urges. Causes nocturia. -decreased muscle tone in perineal floor & weakened sphincter causing stress incontinence in females (ex. sneezes can cause accidents) -decreased elasticity due to decrease in collagen related to drops in estrogen. |
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What complications occur when there is decreased bladder tone? |
-post void residual (PVR) -UTIs -Males: BPH which is an enlargement of the prostate. causes urinary retention. PSA (prostate specific antigen) is a blood draw to measure levels. Elevated levels (greater than 10) - BPH, prostate cancer or inflammation of prostate. (osteoporosis, ejaculation and vigorous exercise can increase it as well). Draw blood before rectal exam. -Females: atrophy of vagina due to decreased estrogen. lowered PH due to lowered lactobacili so e.coli can grow causing UTI |
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How do you prevent urinary complications? |
-Tell elderly to limit fluids when away from home -reduce intake at bed time -bladder training & kegel exercise to strengthen pelvic floor -Meds to treat overactive bladder |
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Libido in elderly |
-not decreased in elderly. The frequency is what declines. |
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Female reproductive changes |
-fat replaces granular tissue in breast -menopause does not effect libido -decrease in vagina lubrication -atrophy of vagina -increase in breast cancer over 50 |
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What increases risk of breast cancer? |
-family history -reach menarche (first period) before age of 12 (exposed to estrogen longer) -menopause after 55 yo (longer exposure) -no children or child birth after age 30 -alcohol consumption, 2-5 drinks per day (alcohol increase estrogen in blood) -obesity and diet high in fat (fat cells store estrogen) |
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Male reproductive changes |
-testicles decrease in size but fertility potency unaffected. -low intensity ejaculation -erection is slower to achieve but last longer |
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How does cognitive ability change in elderly? |
It does not change much with aging. Elderly continue to learn. Intelligence and personality remain consistent. -short term memory affected but long term memory intact. |
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Dementia |
degeneration of brain tissue -irreversible and no cure -slow onset & is hidden by person or family -gradual onset & continuous decline -leads to impaired social and occupational function -problems with memory, thinking, judgment, & problem solving. |
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Aphasia |
occurs with dementia -receptive aphasia - cannot comprehend what is being said -expressive aphasia - cannot form words -global aphasia - lose of all language ability |
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Vascular dementia |
A type of dementia that results from recurrent sub clinical stroke (CVS) |
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Other causes of dementia |
-aids -alcoholism -Parkinson's disease -trauma to the brain -brain tumors -vitamin b12 deficiency affects CNS -side effects of meds for psychosis and anxiety |
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Alzheimer's disease |
Form of dementia (accounts for 2/3 of dementia) -gradual deterioration Causes: -inflammatory process (use it or lose it) -gene related Diagnosis: MRI shows hypocampus shrinkage, PET scan, & genetic testing. |
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Periods of Alzheimer's disease |
-Latent period - disease occurs before symptoms show (exist but not manifested). Mild cognitive impairment, short term memory impairment. -Early stage - moderately working memory loss, language problems & depression -Moderate stage - short & long term memory loss, more severe language loss, pt wanders, aggressive behavior, and hallucinations. -Advanced - complete loss of memory, bed ridden, vegetative state, can be death. |
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Risk factors of Alzheimer's disease |
risks increase with age, peak and 90s then decline in mid 90s
-first degree relatives with Alzheimer's -head trauma especially young adult -females more at risk than men -High BP and high cholesterol (LDL) -low fruit and vege, high fat, low fish (no omega 3), low vitamin E diets in mid life |
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Medications for Alzheimer's disease |
-Aricept -memantine Namzaric - brings back memory -exercise the brain - puzzles, learn one thing at a time, etc Nursing care: first is about safety because they cannot care for their own safety |
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Delirium |
Organic or chronic brain syndrome -acute onset (something triggers it) -if treated properly, can be reversed. -Causes: reaction to meds (such as benadryl), polypharmacy (4 or more drug interaction), acute illness such as infection or metabolic disorder (even if no fever), urinary & gi issues. |
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Characteristics of delirium |
-confusion (don't know the day or where you are) -decrease attentions pan -lower level of consciousness -disturbance in sleep and wake cycle |
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Confusion |
Caused by -drug interactions -circulatory problems -nutritional problems -sensory alterations *Sundowning - type of confusion occuring at night |
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Depression |
Caused by -loneliness -poverty -dependence for the first time *increased suicide - elderly white men |
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Disengagement theory |
Elderly people are withdrawn from society -mutual agreement between elderly and society -stronger relationship with friends and relatives |
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Activity theory |
Healthy aging keeps activity. Substitute and alter activity as changes occur with aging. |
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Erikson's elderly theory |
Integrity V. Despair -occurs at age 60 to death -look fwd but also look back on their life -if in despair, will want to relive life due to poor choices |
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Stochastic & Nonstochastic theory |
Stochastic - again is a result of random cellular damage Nonstochastic - genetic programming |
