Older Adults chapter 14
1. Principles for promoting older adult learning
Principles for Promoting Older-Adult Learning
• Make sure that the patient is ready to learn before trying to teach. Watch for clues that
indicate that the patient is preoccupied or too anxious to comprehend the material.
• Is the patient physically well enough to be taught? Is he or she in pain?
• Sit facing the patient so he or she is able to watch your lip movements and facial
expressions.
• Speak slowly and in a normal tone of voice.
• Present one idea or concept at a time.
• Emphasize concrete rather than abstract material.
• Give the patient enough time in which to respond because older adults process information
slower than younger persons.
• Keep environmental distractions to a minimum. Provide appropriate lighting and a
comfortable setting.
• Defer teaching if the patient becomes distracted or tired or cannot concentrate for other
reasons.
• Invite another member of the household to join the discussion.
• Use audio, visual, and tactile cues to enhance learning and help the patient remember
information.
• Ask for feedback to ensure that the patient understands the information.
• Use past experience; connect new learning to previous knowledge.
2. Presentation of illness in older adults; acute care, restorative care
3. Comparison of clinical presentation of delirium, dementia and depression;
nursing implications
Delirium, or acute confusional state, is potentially a reversible cognitive impairment that often
has a physiological cause.
Physiological causes include electrolyte imbalances; cerebral anoxia; hypoglycemia; medication
effects; tumors; subdural hematomas; and cerebrovascular infection, infarction, or hemorrhage.
Delirium in older adults sometimes accompanies systemic infections and is often the
presenting symptom for pneumonia or urinary tract infection.
Sometimes it is also caused by environmental factors such as sensory deprivation or
unfamiliar surroundings or psychosocial factors such as emotional distress or pain.
, Sleep deprivation is another possible reason for delirium.
Dementia is a generalized impairment of intellectual functioning that interferes with social and
occupational functioning. It is an umbrella term that includes Alzheimer's disease, Lewy body disease,
frontal-temporal dementia, and vascular dementia.
Cognitive function deterioration leads to a decline in the ability to perform basic ADLs and
IADLs.
Nursing management of older adults with any form of dementia always considers the safety and
physical and psychosocial needs of the older adult and the family
Depression: is the most common, yet most undetected and untreated, impairment in older adulthood. Co-
occurring diseases may include stroke, dementia, Parkinson's disease, heart disease, cancer, and pain-
provoking diseases such as arthritis. Loss of a significant loved one or a nursing center admission may
precipitate depression.
Clinical depression is treatable and includes medication, psychotherapy, or a combination of
both.
4. Sexuality in the older adult
All older adults, whether healthy or frail, need to express their sexual feelings. Sexuality involves
love, warmth, sharing, and touching, not just the act of intercourse. Sexuality plays an important
role in helping the older adult maintain self-esteem.
To help an older adult achieve or maintain sexual health, you need to understand the physical
changes in a person's sexual response you need to provide privacy for any discussion of sexuality
and maintain a nonjudgmental attitude. Open-ended questions inviting the older adult to explain
sexual activities or concerns elicit more information than a list of closed-ended questions about
specific activities or symptoms. Include information about the prevention of sexually transmitted
infections when appropriate. Sexuality and the need to express sexual feelings remain throughout
the human life span
5. Health concerns; health promotion and maintenance, stroke, smoking,
alcohol abuse, safety; nursing implications
Cerebrovascular accidents (CVAs) continue to be the third leading cause of death in the United
States and occur as brain ischemia (inadequate blood supply to areas of brain caused by arterial
blockage) or brain hemorrhage
Risk factors for CVAs include: hypertension, hyperlipidemia, diabetes mellitus, history of
transient ischemic attacks, and family history of cardiovascular disease.
** CVAs often impair the functional abilities of older adults and lead to the inability to live
independently.
, Nursing interventions: The scope of nursing interventions ranges from teaching older adults
about risk-reduction strategies to teaching family caregivers the early warning signs of a stroke
and ways to support a patient during recovery and rehabilitation.
Smoking
Cigarette smoking is a risk factor among the four most common causes of death: heart disease,
cancer, stroke, and lung disease. Smoking is the most preventable cause of disease and death in
the United States
Smoking cessation is a health promotion strategy for older adults just as it is for younger adults.
Older smokers still benefit from smoking cessation. In addition to reducing risk, it sometimes
stabilizes existing conditions such as chronic obstructive pulmonary disease (COPD) and
coronary artery disease
Nursing interventions
If the patient rejects smoking cessation, suggest at least a reduction in smoking. Finally, arrange
with the older adult a quit or reduction date and a follow-up visit or contact to discuss the quit
attempt. At follow-up visits, offer encouragement and assistance in modifying the plan as
necessary.
Alcohol Abuse
Alcoholism can be found in older adults. Alcohol is inexpensive, legal, and accessible. Studies of
alcohol abuse in older adults report two patterns: a lifelong pattern of heavy drinking that
continues and a pattern when heavy drinking begins late in life. Frequently cited causes of
excessive alcohol use are depression, loneliness, and lack of social support.
Alcohol abuse may be underidentified in older adults. The clues to creating suspicion of alcohol
abuse are subtle, and coexisting dementia or depression sometimes complicates the assessment.
Suspicion of alcohol abuse increases when there is a history of repeated falls and accidents, social
isolation, recurring episodes of memory loss and confusion, failure to meet home and work
obligations, a history of skipping meals or medications, and difficulty managing household tasks
and finances
Nursing interventions
When you suspect that an older adult is abusing alcohol, realize that a variety of treatment needs
are present. Treatment includes age-specific approaches that acknowledge the stresses
experienced by the older adult and encourage involvement in activities that match the older
adult's interests and increase feelings of self-worth. The identification and treatment of co-
existing depression are also important. The continuum of interventions can range from simple
education to formalized treatment programs that include pharmacotherapy, psychotherapy, and
rehabilitation.
6. Therapeutic communication; reality orientation, validation therapy,
reminiscence
Therapeutic communication skills enable you to perceive and respect the older adult's uniqueness
and health care expectations. Attentive nurses provide care in a timely fashion, meeting a patient's
expressed or unexpressed needs. A caring nurse expresses attitudes of concern, kindness, and
compassion.
1. Principles for promoting older adult learning
Principles for Promoting Older-Adult Learning
• Make sure that the patient is ready to learn before trying to teach. Watch for clues that
indicate that the patient is preoccupied or too anxious to comprehend the material.
• Is the patient physically well enough to be taught? Is he or she in pain?
• Sit facing the patient so he or she is able to watch your lip movements and facial
expressions.
• Speak slowly and in a normal tone of voice.
• Present one idea or concept at a time.
• Emphasize concrete rather than abstract material.
• Give the patient enough time in which to respond because older adults process information
slower than younger persons.
• Keep environmental distractions to a minimum. Provide appropriate lighting and a
comfortable setting.
• Defer teaching if the patient becomes distracted or tired or cannot concentrate for other
reasons.
• Invite another member of the household to join the discussion.
• Use audio, visual, and tactile cues to enhance learning and help the patient remember
information.
• Ask for feedback to ensure that the patient understands the information.
• Use past experience; connect new learning to previous knowledge.
2. Presentation of illness in older adults; acute care, restorative care
3. Comparison of clinical presentation of delirium, dementia and depression;
nursing implications
Delirium, or acute confusional state, is potentially a reversible cognitive impairment that often
has a physiological cause.
Physiological causes include electrolyte imbalances; cerebral anoxia; hypoglycemia; medication
effects; tumors; subdural hematomas; and cerebrovascular infection, infarction, or hemorrhage.
Delirium in older adults sometimes accompanies systemic infections and is often the
presenting symptom for pneumonia or urinary tract infection.
Sometimes it is also caused by environmental factors such as sensory deprivation or
unfamiliar surroundings or psychosocial factors such as emotional distress or pain.
, Sleep deprivation is another possible reason for delirium.
Dementia is a generalized impairment of intellectual functioning that interferes with social and
occupational functioning. It is an umbrella term that includes Alzheimer's disease, Lewy body disease,
frontal-temporal dementia, and vascular dementia.
Cognitive function deterioration leads to a decline in the ability to perform basic ADLs and
IADLs.
Nursing management of older adults with any form of dementia always considers the safety and
physical and psychosocial needs of the older adult and the family
Depression: is the most common, yet most undetected and untreated, impairment in older adulthood. Co-
occurring diseases may include stroke, dementia, Parkinson's disease, heart disease, cancer, and pain-
provoking diseases such as arthritis. Loss of a significant loved one or a nursing center admission may
precipitate depression.
Clinical depression is treatable and includes medication, psychotherapy, or a combination of
both.
4. Sexuality in the older adult
All older adults, whether healthy or frail, need to express their sexual feelings. Sexuality involves
love, warmth, sharing, and touching, not just the act of intercourse. Sexuality plays an important
role in helping the older adult maintain self-esteem.
To help an older adult achieve or maintain sexual health, you need to understand the physical
changes in a person's sexual response you need to provide privacy for any discussion of sexuality
and maintain a nonjudgmental attitude. Open-ended questions inviting the older adult to explain
sexual activities or concerns elicit more information than a list of closed-ended questions about
specific activities or symptoms. Include information about the prevention of sexually transmitted
infections when appropriate. Sexuality and the need to express sexual feelings remain throughout
the human life span
5. Health concerns; health promotion and maintenance, stroke, smoking,
alcohol abuse, safety; nursing implications
Cerebrovascular accidents (CVAs) continue to be the third leading cause of death in the United
States and occur as brain ischemia (inadequate blood supply to areas of brain caused by arterial
blockage) or brain hemorrhage
Risk factors for CVAs include: hypertension, hyperlipidemia, diabetes mellitus, history of
transient ischemic attacks, and family history of cardiovascular disease.
** CVAs often impair the functional abilities of older adults and lead to the inability to live
independently.
, Nursing interventions: The scope of nursing interventions ranges from teaching older adults
about risk-reduction strategies to teaching family caregivers the early warning signs of a stroke
and ways to support a patient during recovery and rehabilitation.
Smoking
Cigarette smoking is a risk factor among the four most common causes of death: heart disease,
cancer, stroke, and lung disease. Smoking is the most preventable cause of disease and death in
the United States
Smoking cessation is a health promotion strategy for older adults just as it is for younger adults.
Older smokers still benefit from smoking cessation. In addition to reducing risk, it sometimes
stabilizes existing conditions such as chronic obstructive pulmonary disease (COPD) and
coronary artery disease
Nursing interventions
If the patient rejects smoking cessation, suggest at least a reduction in smoking. Finally, arrange
with the older adult a quit or reduction date and a follow-up visit or contact to discuss the quit
attempt. At follow-up visits, offer encouragement and assistance in modifying the plan as
necessary.
Alcohol Abuse
Alcoholism can be found in older adults. Alcohol is inexpensive, legal, and accessible. Studies of
alcohol abuse in older adults report two patterns: a lifelong pattern of heavy drinking that
continues and a pattern when heavy drinking begins late in life. Frequently cited causes of
excessive alcohol use are depression, loneliness, and lack of social support.
Alcohol abuse may be underidentified in older adults. The clues to creating suspicion of alcohol
abuse are subtle, and coexisting dementia or depression sometimes complicates the assessment.
Suspicion of alcohol abuse increases when there is a history of repeated falls and accidents, social
isolation, recurring episodes of memory loss and confusion, failure to meet home and work
obligations, a history of skipping meals or medications, and difficulty managing household tasks
and finances
Nursing interventions
When you suspect that an older adult is abusing alcohol, realize that a variety of treatment needs
are present. Treatment includes age-specific approaches that acknowledge the stresses
experienced by the older adult and encourage involvement in activities that match the older
adult's interests and increase feelings of self-worth. The identification and treatment of co-
existing depression are also important. The continuum of interventions can range from simple
education to formalized treatment programs that include pharmacotherapy, psychotherapy, and
rehabilitation.
6. Therapeutic communication; reality orientation, validation therapy,
reminiscence
Therapeutic communication skills enable you to perceive and respect the older adult's uniqueness
and health care expectations. Attentive nurses provide care in a timely fashion, meeting a patient's
expressed or unexpressed needs. A caring nurse expresses attitudes of concern, kindness, and
compassion.
