– Reduce safety risks and promote health;
– Improve older adults quality of life; and
– Understand age-related changes are major contributors to Geriatric Syndromes.
– Slowed wound healing;
– Increased susceptibility to infection; and
– Flattening of epidermal-dermal junction = increased risk of tearing.
– Decreased pain sensation; and
– Increased risk of injury.
– Decreased fat = increased injury & brusing;
– Decreased sebaceous glands = drying of skin, itching; and
– Decreased vitamin D absorption = osteoporosis.
– Daily skin inspection with careful assessment and documentation;
– Protect and prevent tearing;
– Maintain hydration & nutrition;
– Moisturize the skin;
– Frequent position changes if immobile;
– Be aware of heat/cold intolerance;
– Do not rely on verbalization of pain – inspect; and
– Monitor healing of wounds.
– Decreased elasticity & recoil of artieries = orthostatic hypotension;
– Atherosclerosis, LDL elevation, increased SBP & DBP = Arteriosclerosis; and
– Decreased elasticity in veins = valve stiffness = edema = the heart has to work harder to return blood.
– Exercise is good but in moderation (don’t over exert);
– Watch for orthostasis, especially with anti-hypertensives;
– Slow down changes of position;
– Dependent edema is common, but *pitting edema is NOT normal*;
– Assess smoking/exposure to environmental pollutants;
– Help with stress management; and
– Help maintain weight & nutrition.
– Increased stiffening of chest wall;
– Decreased lung expansion & decreased tidal volume;
– Decreased vital capacity (amount exhaled);
– Increased residual volume;
– Weakened cough reflex, ciliary function = increased risk of pneumonia, aspiration; and
– Decreased number of functional alveoli = decreased alveolar surface area = decreased PaO2 (ABG) & less efficient gas exchange.
– Encourage physical activity (as tolerated) to maintain lung condition and help expel substances;
– Encourage regular deep breathing & coughing if on bed rest or at risk for respiratory infection;
– Monitor for atypical presentation; and
– Encourage immunizations – influenza & pneumococcal
– Loss of accommodation (dark/light);
– Increased glare sensitivity;
– Decreased peripheral and night vision;
– Yellowing of lens;
– Decreased color discrimination; and
– Decreased contrast sensitivity.
*Vision loss is not normal, just changes/difficulty*
– Provide larger font print (14pt minimum), high contrast (B/W)
– Use block style printing & avoid cursive lettering;
– Ensure pt’s glasses are within reach / available to pt; and
– Suggest using a magnifier for small print / difficulty reading.
– Presbycusis (sensorineural hearing loss)
– High frequency (pitch) hearing loss occurs first / most commonly >>> soft consonants “T&D” and “S&F” are hard to distinguish
– Hearing assistive devices (available);
– Lower the pitch/tone of your voice when speaking to the pt;
– Speak directly to the older adult (facing them); and
– Reduce background noise.
– Increased connective tissue; and
– Decreased synovial fluid in joints = decreased joint mobility.
– Decreased mineral density; and
– Loss of height (< 2 inches is normal, *2-3+ is not normal*) *Kyphosis is common but not normal*
– Prevent falls (assess risk);
– Daily activity: get OOB to maintain muscle, strength, and balance;
– Encourage weight-bearing; and
– Promote safe walking: proper footwear, de-cluttered room/pathway, wider base of support
– Decreased kidney size & function; and
– Decreased GFR (impaired ability to concentrate urine).
– Decreased bladder size;
– Increased nocturnal diuresis;
– Decreased urine flow rate & increased residual volume
*Incontinence is common but not normal*
– Prevent dehydration;
– Monitor need to adjust dosages of medications that require renal excretion; and
– Prevent incontinence = increase toiletry frequency d/t less ability to delay.
– Decreased appetite & increased difficulty masticating;
– Decreased smell, thirst, and taste;
– Decreased tooth enamel (brittle) & dentin deterioration;
– Diminished oral muscle strength;
– Dry mouth; and
– Less effective swallowing (dysphagia) d/t decreased esophageal propulsion & emptying.
– Decreased absorption of Ca, lactose, vitamin D, zinc, B12; and
– Increased bacterial overgrowth = malabsorption & malnutrition.
– Maintain upright position if possible;
– Hydration is critical for regular bowel movements;
– Prevent & assess for constipation: monitor medications, especially narcotics;
– Encourage fiber-rich diet – fruits & vegetables;
– Encourage daily physical activity;
– Provide smaller, more frequent meals;
-Ensure glasses, hear aids, and appropriate utensils are available;
– Monitor pain.
– Decrease in brain weight & size; and
– Decrease in neurotransmitters.
– Loss of motor neurons;
– Decrease in vibratory sensation;
– Decrease in tactile sensitivity; and
– Decrease in proprioception & “righting reflex” = increase in body sway.
– Inspect feet daily;
– Use caution with heat/cold applications;
– Orient frequently, use memory aids;
– Provide social engagement; and
– Use principles of patient education.
*Significant memory loss is not normal*
– Decreased pancreatic beta cell function = insulin resistance;
– Increase in ADH release = Na loss & hyponatremia, voiding less volume
– Decreased melatonin = sleep problems.
– Monitor for electrolyte imbalance; and
– Promote restful sleep by maintaining regular wake/sleep schedule, lowered lights/voices at night, minimal interruptions.