Older Adult Final
● Geriatric Syndromes-groups of s&s that occur in older adults and impact morbidity and mortality - SPICES-
○ Result from normal aging, changes, multiple comorbidities, and adverse events from therapeutic
intervention
○ Sleep disorders
○ Problems with eating and feeding
○ Pain
○ Incontinence
○ Confusion
○ Evidence of falls
○ Skin break down
● Sleep
○ How is it different for older adult
○ Increased sleep latency
■ Delay in the onset of sleep
■ Takes longer to go to sleep
○ Reduced sleep efficiency
■ Percentage of time in bed spent asleep - this is reduced in the elderly
○ Increased nocturnal awakenings
■ Contribute to an overall decrease in the average # hours of sleep
■ Reasons for nocturnal awakenings: trips to the bathroom, dyspnea, chest pain, arthritis pain,
coughing, snoring, leg cramps, & noise
○ Early to bed early to rise
■ May be related to changes in circadian rhythm or to any of the reasons for nocturnal awakenings
○ Daytime napping
○ Increased daytime sleepiness
■ May be due to frequent nocturnal awakening or other sleep disturbances
■ May suggest underlying disease
■ Contribute to the risk of motor vehicle accidents
■ Predictor of mortality when cognitive dysfunction is present
■ May also be due to medication side effects
○ As an individual ages, the time spent in rapid-eye movement (REM) sleep declines
■ They spend less time in REM sleep
○ Sleep Disorders:
■ Insomnia
■ Sleep apnea
■ Restless leg syndrome
■ REM sleep behavior disorder
■ Circadian rhythm sleep disorder
○ Factors affecting sleep
■ Pain & discomfort: interferes with falling asleep and with staying asleep
■ Lifestyle changes
● Loss of spouse
○ Widowhood leaves older adults without “touch partners”
● Retirement
○ Work activities that caused fatigue have ceased
○ In the absence of old routines, sleep is disturbed
○ Sleep may also be distrubed by the uncertainties that come with retirement
● Relocation
● Having a roommate
■ Dietary influences
● Caffeine
● Alcohol
● Fluid intake
○ Evening and immediately before going to bed is associated with nocturia
● Hunger and thirst can be causes of sleeplessness
■ Drugs influencing sleep
● Prescription and OTC drugs affect sleep in 3 ways:
○ Causing sleep by intent
○ Causing drowsiness by side effect
○ Causing insomnia or other sleep disturbances by side effect
, ○ We want to always do a medication assessment
■ Drugs used to Promote sleep
● Tranquilizers and sedatives àdecrease activity & calm the recipient
● Hypnotics produce drowsiness and facilitate the onset and maintenance of sleep; use for
short time
● Avoid barbiturates, chloral hydrate, antihistamines, & over-the-counter preparations
because of side effects
● Benzodiazepines: most commonly prescribed hypnotics for the older adult
● Age-related changes in the clearance of benzodiazepines increase the risk of prolonged
sedation.
● Complications of benzodiazepine use include daytime drowsiness, increased risk of falls
during the night or in the early morning, confusion, and disorientation.
● Different types of incontinence
○ Incontinence (different types): urinary incontinence is the involuntary loss of urine, which cases a
problem
■ THIS IS NOT A NORMAL PART OF AGING
■ It is underdiagnosed, underreported and undertreated in older adults bc of embarrassment
■ Types of urinary incontinence:
● Transient (acute) or sudden onset (present for 6 mos or less)
○ Causes: UTIs, diabetes, high calcium, delirium, constipation, stool impaction,
increased urine production
○ Iatrogenic incontinence: a type of transient incontinence that is treatment-
induced resulting from the use of restraints, limited fluid intake, bed rest, IV fluid
administration, or meds
○ With this type we want to treat the underlying cause!!
● Established (chronic) - sudden or gradual onset
○ Categorized into one of the following types:
■ Urge - most common type in older adults
● Involuntary urine loss occurs soon after feeling an urgent need to
void (overactive bladder)
■ Stress
● Involuntary loss of less than 50 mL urine (loss of small amt of
urine)
● This is associated with activities that increase the intrabdominal
pressure caused by coughing, sneezing, exercise, lifting, and
bending.
● More common in women
● Low post-void residuals
■ Urge,mixed, or stress with high post-voidal residual (overflow UI)
● Occurs in bladders that do not empty normally and those that
become over-distended with frequency and constant urine loss
(dribbling)
● Doesn’t have muscle tone to fully empty
● Symptoms:
○ Hesitancy in starting urination
○ Slow urine stream
○ Passage of infrequent or small volumes of urine
○ Feelings of incomplete bladder emptying
○ Large post-void residuals
● Diabetes and men with large prostates @ risk
■ Functional and mixed
● Functional: lower urinary tract is intact but the individual is
unable to reach the toilet bc of environmental barriers, physical
limitations, or severe cognitive impairment
● Mixed: combination of more than one type
○ Usually stress + urge
● UTIs
○ Change in mental status
● MIs
○ Change in mental status
● Falls
, ○ Preventing falls: FALLS ARE NOT A NORMAL PART OF AGING
■ Falls: unexpected event in which participant comes to rest on the ground, floor, or lower level
■ We need to find out what caused the fall - it is related to cardiac, dizziness
■ Did they hit their head?
■ Falls in nursing homes and hospitals are called sentinel events - must be reported
■ Falls are a symptom of a problem
■ Fall prevention:
● Wear low-heeled shoes with small wedge platforms
● Wear leather- or rubber-soled shoes
● Leave night light on at night
● Keep items within reach to avoid overreaching
● Check the tips of canes and walkers for evenness
● Paint the last step a different color, indoors and outdoors
● Avoid alcohol
● Avoid rushing
● Avoid risky behavior (standing on ladders)
● Balance, weight bearing exercises
■ Fall prevention - environment
● Avoid slippery falls and frayed carpets
● Watch the last step when descending
● Count number of steps
● Sturdy banisters on both side of steps
● Tack down or remove throw rugs
● Remove obstacles
● Install grab bars in toilets
● Avoid throw rugs/ install carpeting
● Avoid bar soaps/use of liquid soap in shower
■ Fall prevention - Health care settings
● Safety/Falls prevention program
● Personal alarms and bed alarms
● Low beds, floor mats
● Regular, systematic, observation (Rounds)
● Toileting Rounds
● Keep bedpan, urinal handy
● ID bands/Red Socks
● Room allowing for frequent observation by staff
● One to one sitter
● Engaging patient in activities
● Ambulation, ROM exercises prevent deconditioning
● Use of walkers, canes, devices
● Pressure Ulcers
○ STAGES OF ULCERS:
● Geriatric Syndromes-groups of s&s that occur in older adults and impact morbidity and mortality - SPICES-
○ Result from normal aging, changes, multiple comorbidities, and adverse events from therapeutic
intervention
○ Sleep disorders
○ Problems with eating and feeding
○ Pain
○ Incontinence
○ Confusion
○ Evidence of falls
○ Skin break down
● Sleep
○ How is it different for older adult
○ Increased sleep latency
■ Delay in the onset of sleep
■ Takes longer to go to sleep
○ Reduced sleep efficiency
■ Percentage of time in bed spent asleep - this is reduced in the elderly
○ Increased nocturnal awakenings
■ Contribute to an overall decrease in the average # hours of sleep
■ Reasons for nocturnal awakenings: trips to the bathroom, dyspnea, chest pain, arthritis pain,
coughing, snoring, leg cramps, & noise
○ Early to bed early to rise
■ May be related to changes in circadian rhythm or to any of the reasons for nocturnal awakenings
○ Daytime napping
○ Increased daytime sleepiness
■ May be due to frequent nocturnal awakening or other sleep disturbances
■ May suggest underlying disease
■ Contribute to the risk of motor vehicle accidents
■ Predictor of mortality when cognitive dysfunction is present
■ May also be due to medication side effects
○ As an individual ages, the time spent in rapid-eye movement (REM) sleep declines
■ They spend less time in REM sleep
○ Sleep Disorders:
■ Insomnia
■ Sleep apnea
■ Restless leg syndrome
■ REM sleep behavior disorder
■ Circadian rhythm sleep disorder
○ Factors affecting sleep
■ Pain & discomfort: interferes with falling asleep and with staying asleep
■ Lifestyle changes
● Loss of spouse
○ Widowhood leaves older adults without “touch partners”
● Retirement
○ Work activities that caused fatigue have ceased
○ In the absence of old routines, sleep is disturbed
○ Sleep may also be distrubed by the uncertainties that come with retirement
● Relocation
● Having a roommate
■ Dietary influences
● Caffeine
● Alcohol
● Fluid intake
○ Evening and immediately before going to bed is associated with nocturia
● Hunger and thirst can be causes of sleeplessness
■ Drugs influencing sleep
● Prescription and OTC drugs affect sleep in 3 ways:
○ Causing sleep by intent
○ Causing drowsiness by side effect
○ Causing insomnia or other sleep disturbances by side effect
, ○ We want to always do a medication assessment
■ Drugs used to Promote sleep
● Tranquilizers and sedatives àdecrease activity & calm the recipient
● Hypnotics produce drowsiness and facilitate the onset and maintenance of sleep; use for
short time
● Avoid barbiturates, chloral hydrate, antihistamines, & over-the-counter preparations
because of side effects
● Benzodiazepines: most commonly prescribed hypnotics for the older adult
● Age-related changes in the clearance of benzodiazepines increase the risk of prolonged
sedation.
● Complications of benzodiazepine use include daytime drowsiness, increased risk of falls
during the night or in the early morning, confusion, and disorientation.
● Different types of incontinence
○ Incontinence (different types): urinary incontinence is the involuntary loss of urine, which cases a
problem
■ THIS IS NOT A NORMAL PART OF AGING
■ It is underdiagnosed, underreported and undertreated in older adults bc of embarrassment
■ Types of urinary incontinence:
● Transient (acute) or sudden onset (present for 6 mos or less)
○ Causes: UTIs, diabetes, high calcium, delirium, constipation, stool impaction,
increased urine production
○ Iatrogenic incontinence: a type of transient incontinence that is treatment-
induced resulting from the use of restraints, limited fluid intake, bed rest, IV fluid
administration, or meds
○ With this type we want to treat the underlying cause!!
● Established (chronic) - sudden or gradual onset
○ Categorized into one of the following types:
■ Urge - most common type in older adults
● Involuntary urine loss occurs soon after feeling an urgent need to
void (overactive bladder)
■ Stress
● Involuntary loss of less than 50 mL urine (loss of small amt of
urine)
● This is associated with activities that increase the intrabdominal
pressure caused by coughing, sneezing, exercise, lifting, and
bending.
● More common in women
● Low post-void residuals
■ Urge,mixed, or stress with high post-voidal residual (overflow UI)
● Occurs in bladders that do not empty normally and those that
become over-distended with frequency and constant urine loss
(dribbling)
● Doesn’t have muscle tone to fully empty
● Symptoms:
○ Hesitancy in starting urination
○ Slow urine stream
○ Passage of infrequent or small volumes of urine
○ Feelings of incomplete bladder emptying
○ Large post-void residuals
● Diabetes and men with large prostates @ risk
■ Functional and mixed
● Functional: lower urinary tract is intact but the individual is
unable to reach the toilet bc of environmental barriers, physical
limitations, or severe cognitive impairment
● Mixed: combination of more than one type
○ Usually stress + urge
● UTIs
○ Change in mental status
● MIs
○ Change in mental status
● Falls
, ○ Preventing falls: FALLS ARE NOT A NORMAL PART OF AGING
■ Falls: unexpected event in which participant comes to rest on the ground, floor, or lower level
■ We need to find out what caused the fall - it is related to cardiac, dizziness
■ Did they hit their head?
■ Falls in nursing homes and hospitals are called sentinel events - must be reported
■ Falls are a symptom of a problem
■ Fall prevention:
● Wear low-heeled shoes with small wedge platforms
● Wear leather- or rubber-soled shoes
● Leave night light on at night
● Keep items within reach to avoid overreaching
● Check the tips of canes and walkers for evenness
● Paint the last step a different color, indoors and outdoors
● Avoid alcohol
● Avoid rushing
● Avoid risky behavior (standing on ladders)
● Balance, weight bearing exercises
■ Fall prevention - environment
● Avoid slippery falls and frayed carpets
● Watch the last step when descending
● Count number of steps
● Sturdy banisters on both side of steps
● Tack down or remove throw rugs
● Remove obstacles
● Install grab bars in toilets
● Avoid throw rugs/ install carpeting
● Avoid bar soaps/use of liquid soap in shower
■ Fall prevention - Health care settings
● Safety/Falls prevention program
● Personal alarms and bed alarms
● Low beds, floor mats
● Regular, systematic, observation (Rounds)
● Toileting Rounds
● Keep bedpan, urinal handy
● ID bands/Red Socks
● Room allowing for frequent observation by staff
● One to one sitter
● Engaging patient in activities
● Ambulation, ROM exercises prevent deconditioning
● Use of walkers, canes, devices
● Pressure Ulcers
○ STAGES OF ULCERS:
