IMPLEMENTATION

Implementation
 Implementation is the step which involves action or doing and the actual carrying out of nursing
interventions outlined in the plan of care
Physical Care of Older Adults
 The body gradually changes over time as we age. These changes are expected and usually
depend on family patterns of aging or lifestyle choices made throughout the lifespan.
 Changes that are a result of a pre-existing medical condition are not considered to be a part of
healthy aging. Most of the time, normal age-related changes on the physical level include the
following:
o Aging Skin and Mucous Membranes
o Elimination
o Activity and Exercise
o Sleep and Rest
Aging Skin and Mucous Membranes
 The skin undergoes several changes with aging that make it more susceptible to damage.
 Over time, the epidermal layer becomes thinner and subcutaneous padding diminishes,
increasing the risk for traumatic injuries such as skin tears or pressure ulcers
SKIN-EPIDERMIS
 The number of epidermal cells decreases by 10% per decade and they divide more slowly
making the skin less able to repair itself quickly.
 Epidermal cells become thinner making the skin look noticeably thinner.
 Changes in the epidermis allows more fluid to escape the skin.
SKIN-IN BETWEEN
 The rete-ridges of the dermal-epidermal junction flatten out
 Making the skin more fragile and making it easier for the skin to shear.
 This process also decreases the amount of nutrients available to the epidermis by decreasing the
surface area in contact with the dermis.
= slower repair/turnover
SKIN-DERMIS
These changes cause the skin to wrinkle and sag.
 The dermal layer thins.
 Less collagen is produced.
 The elastin fibers that provide elasticity wear out.
 Decrease in the function of sebaceous & sweat glands contributes to dry skin.
 The fat cells get smaller. This leads to more noticeable wrinkles and sagging.
SKIN-TOES & NAILS
 Toes & nails become thicker & more difficult to cut.
 Grow more slowly.
 May have a yellowish color.
HAIR- Men
 Most men lose the hair about their temples during their 20s.
 Hairline recedes or male pattern baldness may occur.
 Increased hair growth in ears, nostrils, & on eyebrows.
 Loss of body hair.
Hair- Women
 Usually do not bald, but may experience a receding hairline.
 Hair becomes thinner.
  Increased hair growth about chin & around lips.
 Loss of body hair.
Common Health Problems
Skin
Pressure sores
Skin tears or Pressure ulcers
 previously called decubitus ulcers, pressure sores, or bedsores.
 any lesion caused by unrelieved pressure (a compressing downward force on a body area) that
results in damage to underlying pressure.
 Pressure ulcers are a particular risk to older adults who suffer from compromised circulation,
restricted mobility, altered level of consciousness, fecal or urinary incontinence, or nutritional
problems

Stages of pressure ulcers

 Stage I – nonblanchable erythema signaling potential ulceration
 Stage II – partial thickness skin loss (abrasion, blister or shallow crater) involving the epidermis
& dermis.
 Stage III – full thickness skin involving damage or necrosis of subcutaneous tissue that may
extend down to, but not through underlying fascia.
 Stage IV – full thickness skin loss with tissue necrosis or damage to muscle, bone or supporting
structures such as tendon or joint capsule.
Braden risk assessment tool
 The Braden Scale is a scale made up of six subscales, which measure elements of risk that
contribute to either higher intensity and duration of pressure, or lower tissue tolerance for
pressure.
Braden risk assessment tool
 The Braden Scale is a scale made up of six subscales, which measure elements of risk that
contribute to either higher intensity and duration of pressure, or lower tissue tolerance for
pressure.
 These are: sensory perception, moisture, activity, mobility, friction, and shear, nutrition
Nursing Interventions
 Avoid solar exposure
 Cloth dress appropriately for temperature
 Maintain a safe indoor temperature
 Bath only 1-2 times weekly
 Excessive use of soap should be avoided
 Apply cream for lubricate skin

Implementation
Implementation: Elimination
 Digestive and urinary disorders are the usual health problems faced by older adults.
 Despite the fact that elderly individuals have more time to relax and enjoy their lives, problems
with digestion tend to occur all of a sudden.
 One of the most common problems with aging individuals is constipation.
 As people get into their 60s, bowel habits change.
 Painful and infrequent bowel movements are associated with hard and dry stools that can lead
to hemorrhoids and other health-related concerns.
Constipation
 Constipation is defined as having fewer than three bowel movements a week.
 Constipation also encompasses the passing of hard, dry bowel motions (stools) that are
infrequent, difficult to pass, or both (Better Health Channel 2014).

Constipation in Elderly People: Reasons include:

 Side-effect of certain medications, e.g. medications for pain, antidepressants, anticonvulsants,
and antihistamines
 A possible lack of interest with regard to eating
 Slowing or weakening of the digestive system as a result of ageing and/or frailty.
 Poor diet or lack of adequate fluids in diet, and/or a lack of exercise.
 Urinary/stress incontinence is common in older adults.
 Absence of teeth can make it difficult to eat regular meals.

Common Types of Constipation

in the Elderly
 Normal transit constipation
o a common type of primary constipation.
o Though a stool passes through the colon at a regular pace, patients perceive difficulty in passing
bowel motions.
 Slow-transit constipation
o predominately affects women.
o Bowel movements are infrequent, limited in their urgency or straining is involved
 Pelvic floor dysfunction
o patients are experiencing difficulty in coordinating pelvic floor muscles or muscles around the
anus during defecation.
o This often creates a feeling of an incomplete bowel motion.

Implementation: Constipation
Implementation: Activity and Exercise
 A number of factors cause an older individual to limit his/her physical activity.
 The most common concern in the aging is brittle bones in both the arms and legs.
 Basically, as we reach 30, bone marrow gradually disappears and calcium production is reduced.
 Bone marrow is the soft and spongy tissue found inside the large bones responsible for the
production of platelets, and red and white blood cells.
 Changes in bone mass and bone marrow structure can put an elderly at the risk for infection,
osteoporosis and other bone-related health issues.

Common Barriers to Exercise in Older Adults

Implementation: Sleep and Rest
 Sleep patterns change as we get older. Other than physical changes, people in their later
adulthood tend to have a difficult time falling asleep, and they have a harder time staying asleep
as they age.
 Although research tells us that sleep does not decline with age, several seniors are still
complaining because of changes in their sleeping pattern.
 Sleep is a vital mechanism, regardless of your age.
  It has the ability to restore energy levels and heal both physical and cognitive damage.
 A regular sleeping pattern of 7.5–9 hours per night is recommended to help people function at
their best.
 However, as we get older, a number of factors combine and make this harder to achieve.

5 Common Causes of Sleep Problems in Older Adults

 Sleep problems due to an underlying medical problem
 Snoring, Sleep Apnea, and other forms of Sleep-Related Breathing Disorders. Sleep-related
breathing disorders (“SRBD”; it’s also sometimes called sleep-disordered breathing) is an
umbrella term covering a spectrum of problems related to how people breathe while asleep.
 Restless leg syndrome (RLS)
 Periodic Limb Movements of Sleep (PLMS).
 Insomnia.

Proven Ways to Treat Insomnia in Older Adults

 Insomnia is a very common complaint among family caregivers and older adults. Fortunately,
research has shown that it’s possible to treat insomnia effectively, although it does often take a
little time and effort.
 Before going into the recommended treatments, sedatives should only be used as a last
resort. That’s because most medications that make people sleepy are bad for brain function, in
both the short-term and long-term.

Some proven approaches to improving sleep in older adults

 Cognitive-behavioral therapy for insomnia (CBT-I). This means special therapy that helps a
person avoid negative thought patterns that promote insomnia, along with regular sleep habits,
relaxation techniques, and other behavioral techniques that improve sleep.
 Brief behavioral treatment of insomnia (BBTI). This is a shorter variant of CBT-I; it’s designed to
be delivered in 4 weeks. It also has a good track record in research.
 Mindfulness meditation - is a mental training practice that teaches you to slow down racing
thoughts, let go of negativity, and calm both your mind and body. ... Techniques can vary, but in
general, mindfulness meditation involves deep breathing and awareness of body and mind.
 Exercise. Exercise is often thought of as a treatment for insomnia.

Medications that are less risky and are sometimes used

 Melatonin: Melatonin is a hormone involved in the sleep-wake cycle.
 Ramelteon: Ramelteon is a synthetic drug that mimics the effect of melatonin.
 Trazodone: Trazodone is an older weak anti-depressant that is mildly sedating. It has long been
used by geriatricians as a “sleeping pill” of choice, as it is not anticholinergic and seems to be
less risky than the alternatives.
Psycho- Social Care of Older Adults
Psychosocial need of
an elderly person
 Assisting residents to meet their basic needs includes their emotional and mental well-being,
also called psychosocial needs.
 Therefore, psychosocial needs of the elderly involve mental, social and physical needs among
the aged
Implementation: Psycho- Social Care of Older Adults
 Cognition and Perception
 Self-perception and Self Concept
 Coping and Stress
 Values and Beliefs
 Sexuality and Aging
Psycho- Social Care of Older Adults:
Cognition and Perception
 Cognition describes processes such as remembering, learning, solving problems and orientation.
 Perception refers to ways of obtaining information from our environment
Cognition and Perception:
Common Elderly Mental Health Disorders
 Depression
 Anxiety Disorders
 Bipolar Disorders
 Eating Disorders
Depression
 Is a type of mood disorder that ranks as the most pervasive mental health concern among older
adults.
 If untreated, it can lead to physical and mental impairments and impede social functioning.
 Additionally, depression can interfere with the symptoms and treatment of other chronic health
problems.
 Symptoms include, sadness, problems sleeping, physical pain or discomfort, distancing from
activities previously enjoyed, and a general “slowing down.”
Signs and Symptoms
 Does not get dressed (often attributed to age related inability)
 Does not answer the door or phone
 Feelings of sadness and worthlessness
 Sudden outburst of agitation, crying and anger
 Labile mood
 Sleeping too much or not enough
 Increased appetite, decreased appetite
 Somatic complaints
 Lack of concentration
 Difficulty coping
 Memory issues
 Self-isolation
 Loss of interest or enjoyment
 Talking about suicide
Nursing interventions for Depression
 Nursing interventions for depression include standardized screening tools to assess the elderly
for depression or risk for depression.
 These tools help identify key issues and enable health care professionals to intervene.
o Geriatric Depression Scale
o The Nurses’ Global Assessment of Suicide Risk
o DSMV: Diagnostic Statistical Manual of Mental Disorders
o Client Centered Approach and Recovery Module
Anxiety Disorders
 Like depression, anxiety is a very common mood disorder among the elderly.
 In fact, these two problems often appear in tandem. Statistics from the CDC show that nearly
half of older adults with anxiety also experience depression.
 Anxiety in seniors is thought to be underdiagnosed because older adults tend to emphasize
physical problems and downplay psychiatric symptoms.
 Women in this age group are more likely to be diagnosed with an anxiety disorder than men.
Symptoms and Signs of Generalized Anxiety Disorders in Seniors
 Excessive, uncontrollable worry/anxiety
 Edginess, nervousness, or restlessness
 Chronic fatigue or tiring out easily
 Become irritable or agitated
 Poor quality of sleep or difficulty falling/staying asleep
 Tense muscles
Nursing Intervention: Anxiety
 Learning about anxiety.
 Mindfulness.
 Relaxation techniques.
 Correct breathing techniques.
 Cognitive therapy.
 Behavior therapy.
 Counselling.
 Dietary adjustments
 Exercise
 Learning to assertive
 Building self esteem
 Medication
 Bipolar Disorders
Bipolar disorder
 can affect people of all ages, including older adults. According to one study, 10 percent of new
cases occur after the age of 50. In the past, it was believed that bipolar symptoms "burn out"
and slowly disappear with age.
 are mood disorders characterized by mood swings from profound depression to extreme
euphoria (mania), with intervening periods of normalcy.
Types of Bipolar Disorder
 Bipolar I disorder - a full syndrome of manic or mixed symptoms; the client may also have
experienced periods of depression.
 Bipolar II disorder - characterized by recurrent bouts of major depression with the episodic
occurrence of hypomania; this individual has never experienced a full syndrome of manic or
mixed symptoms.
 Cyclothymic disorder - the essential feature is a chronic mood disturbance of at least 2 years’
duration
 Bipolar disorder due to general medical condition - This disorder is characterized by a
prominent and persistent disturbance in mood (bipolar symptomatology) that is judged to be
the direct result of the physiological effects of a general medical condition (APA, 2000).
 Substance-induced bipolar disorder- the bipolar symptoms associated with this disorder are
considered to be the direct result of the physiological effects of a substance (e.g., use or abuse
of a drug or a medication, or toxin

Clinical Manifestations
 Heightened, grandiose, or agitated mood. The affect of a manic individual is one of elation and
euphoria- a continuous “high”.
 Exaggerated self-esteem. Usual inhibitions are discarded in favor of sexual and behavioral
indiscretions.
 Sleeplessness. Sleep patterns are disturbed; client becomes oblivious to feelings of fatigue, and
rest and sleep are abandoned for days or weeks.
 Pressured speech. Loquaciousness, or pressured speech, is so forceful and strong that it is
difficult to interrupt maladaptive thought processes.
 Flight of ideas. There is a continuous, rapid shift from one topic to another.
 Reduced ability to filter out extraneous stimuli; easily distractible. There is inability to
concentrate because of a limited attention span; the individual is easily distracted by even the
slightest stimulus in the environment.
 Increased number of activities with increased energy. Motor activity is constant; the individual is
literally moving at all times.
 Multiple, grandiose, high risk activities, using poor judgement; with severe consequences.

Medical Management of Bipolar Disorder

 Psychotherapy
 Electroconvulsive therapy
 Diet
 Activity.

Pharmacological Management: Bipolar Disorder

  Anxiolytics, benzodiazepines.
 Mood stabilizers such as lithium (manic episodes)
 Anticonvulsants
 Antipsychotics, 2nd generation
 Antipsychotics, 1st generation
 Antipsychotics, phenothiazine
 Antiparkinsons agents, dopamine agonists

Nursing Interventions: Bipolar Disorder

 Providing for safety. A primary nursing responsibility is to provide a safe environment for client
and others; for clients who feel out of control, the nurse must establish external controls
emphatically and nonjudgmentally.
 Meeting physiologic needs.
 Decreasing environmental stimulation may assist client to relax; the nurse must provide a quiet
environment without noise, television, and other distractions;
 finger foods or things client can eat while moving around are the best options to improve
nutrition.
 Providing therapeutic communication. Clients with mania have short attention spans, so the
nurse uses simple, clear sentences when communicating; they may not be able to handle a lot of
information at once, so the nurse breaks information into many small segments.
 Promoting appropriate behavior. The nurse can direct their need for movement into socially
acceptable, large motor activities such as arranging chairs for a community meeting or walking.
 Managing medications. Periodic serum lithium levels are used to monitor the client’s safety and
to ensure that the dose given has increased the serum lithium level to a treatment level or
reduced it to a maintenance level.

Eating Disorders
 are characterized by a repeated disturbance of eating or eating-related behavior that results in
the altered consumption or absorption of food and that significantly diminishes physical health
or psychosocial functioning
 Eating disorders can be viewed on a continuum, with clients with anorexia nervosa eating too
little or starving themselves, client with bulimia eating chaotically, and clients with obesity
eating too much.
Types of Eating Disorders
 Anorexia Nervosa - life-threatening eating disorder characterized by the client’s refusal or
inability to maintain a minimally normal body weight, intense fear of gaining weight or
becoming fat, significantly disturbed perception of the shape or size of the body, and steadfast
inability or refusal to acknowledge the seriousness of the problem or even that one exists.
 Bulimia Nervosa. Bulimia nervosa, often simply called bulimia, is an eating disorder
characterized by recurrent episodes (at least twice a week for 3 months) of binge eating
followed by inappropriate compensatory behaviors to avoid weight gain such as purging, fasting,
or excessively exercising.

Binge-Eating Disorder (BED). Binge-eating disorder is another eating disorder characterized by recurrent
episodes of binge eating but it is not associated with the recurrent use of inappropriate compensatory
behaviors as in bulimia nervosa, and does not occur exclusively during the course of bulimia nervosa, or
anorexia nervosa methods to compensate for overeating, such as self-induced vomiting.
  Pica. Pica is an eating disorder that involves persistent eating of non-nutritive substances such
as hair, dirt, and paint chips for a period of at least one month.
 Rumination disorder. Rumination disorder is characterized by repeatedly and persistently
regurgitating food after eating, but it’s not due to a medical condition or another eating disorder
such as anorexia nervosa, bulimia nervosa, binge-eating disorder, or avoidant/restrictive food
intake disorder.
 Avoidant/Restrictive Food Intake Disorder (ARFID). Avoidant or restrictive food intake disorder
is an eating or feeding disturbance characterized by persistent failure to meet appropriate
nutritional or energy needs due to having no interest in eating regarding food with certain
sensory characteristics, such as color, texture, smell or taste; or fear of choking.
 Other Specified Feeding or Eating Disorder (OSFED). Other specified feeding or eating disorders
or (OSFED) are eating behaviors that cause clinically compelling distress and impairment in areas
of functioning, but do not meet the full criteria for any of the other feeding and eating disorders.

Nursing Interventions
Establishing nutritional eating patterns.
 When clients can eat, a diet of 1200 to 1500 calories per day is ordered, with gradual increases
in calories until clients are ingesting adequate amounts for height, activity level, and growth
needs;
 the nurse is responsible for monitoring meals and snacks and often initially will sit with a client
during eating at a table away from other clients.
 after each meal or snack, clients may be required to remain in view of staff for 1 to 2 hours to
ensure that they do not empty the stomach by vomiting.

Identifying emotions and developing coping strategies.

 The nurse can help clients begin to recognize emotions such as anxiety or guilt by asking them to
describe how they are feeling and allowing adequate time for response.
Dealing with body image issues.
 The nurse can help clients to accept a more normal body image; this may involve clients
agreeing to weigh more than they would like, to be healthy, and to stay out of the hospital
 help clients to identify areas of personal strength that are not food related broaden client’s
perceptions of themselves.

Psycho- Social Care of Older Adults:

Self-Perception and Self-Concept
 Depression is, unfortunately, a common occurrence among older adults. The fact that their
activities and social interactions are more limited, and their nearest and dearest are often living
far away, makes the adjustment to old age harder. Thus, most elderly face problems with self-
perception and self-concept.
Self-perception
 suggests that individuals infer opinions, attitudes, and internal states mostly through observing
the behavior and circumstances in which they occur.
Self-concept
 is defined as the way an individual think, evaluates and perceives his self.

Nursing Management:
Self-Perception and Self Concept
  Promoting a positive self-perception and self-concept entails a lot of effort on the part of the
caregiver.
 An older adult should be immersed in various social activities to regain a sense of hope and
excitement about life.
 This can be done by making strong social connections within the locality and allowing the elderly
to be involved in activities organized by various support groups.
 Most older adults placed in assisted living facilities interact with and meet other residents who
share similar interests.
 For those who are living in their own home, joining church meetings, local gathering and social
celebrations are helpful ways to foster positive aging.
 Nonetheless, a healthy aging process involves meaningful relationships with the family and
significant others.
 Older adults should not be left at home doing nothing.
 They should be encouraged to engage in family activities and gatherings that minimize isolation.
 Self-perception and self-concept are directly affected by what the person does every day, so
planning in advance is essential to make various activities possible.

Psycho- Social Care of Older Adults:

Coping and Stress
 We all need to face different kinds of mental stress in various stages of life. Chronic and
excessive stress are harmful and can cause physical or mental problems. Therefore we should all
understand more about stress and learn appropriate coping strategies for our physical and
mental wellbeing.
 During emergency situations, stress and anxiety are the natural fight and flight instincts of our
body.
 These stressors can either be external (an intruder crawling through your window) or internal (a
financial problem within the family or worry over an older adult with a mental or physical
problem).
 Stress is the feeling of being overwhelmed or unable to cope with mental or emotional pressure.
 Stress responses help your body adjust to new situations.
 Stress can be positive, keeping us alert, motivated and ready to avoid danger.

SIGNS OF STRESS
 Anxiety or panic attacks
 Worry
 Sadness or depression
 Irritability and moodiness
 Feeling pressured or hurried
 Difficulty concentrating or making decisions
 Sleeping problems
 Physical symptoms like headaches, chest pain, and stomach problem
 Feeling overwhelmed and helpless
 Sexual dysfunction
 Drinking too much alcohol, misusing drugs or smoking a lot
 Not eating enough or eating too much

Physiological
 Insomnia, nightmare
  Loss of appetite, palpitation
 Frequent Urination
 Muscle Pain and Tiredness

Emotional And Psychological

 Anxiety
 Fear
 Frustration, depression
 Restlessness
 Poor concentration
 Forgetfulness

Stress management
 The elderly can share their difficulties and feelings in facing stress, and their way of coping, with
those they can confide (e.g. relatives and friends).
 This helps to ventilate emotions and facilitate the learning of different strategies of coping with
stress.
 An active social life, healthy lifestyle and relaxation exercises are all useful ways to handle stress.
 Healthy dietary habits and regular exercise will also help the elderly cope with stress better.
 Taking a walk in the park or outside the house should be a part of his/her daily routine to
promote proper blood circulation and improve their psychological well-being.
 Engaging in volunteer work is a means to help those who are less fortunate. It also helps to
boost self-confidence and broaden one's outlook in life.
 Positive thinking, such as appreciating one's achievements and strengths, can help to enhance
self-confidence and to cope with stress.
 The elderly can seek help from professionals in case of need. Smoking, drinking and substance
abuse are harmful and should never be used as ways to cope with stress.

Psycho- Social Care of Older Adults:

Values and Beliefs
VALUE
 Values are standards, principles or qualities that a person upholds.
 Values serve as a guide in our lives to make decisions and live the way we think we should.
 A value is usually formed by a particular belief related to a person’s behavior.
 It can influence our judgments and behavior- that is why healthcare workers have to be aware
of a person’s values when taking care of them.
BELIEF
 Beliefs come from real life experiences, but are often forgotten and start to influence us
subconsciously.
 They can significantly affect the quality of our work and personal relationships with colleagues
and friends, and they play a major role in our identity.
 Beliefs may be influenced by our morals, culture and religious affiliations.
 Healthcare staff working with the elderly often have their own pre-existing beliefs and
stereotypes about issues like sexuality, health, alcohol, drug abuse, aging and disabilities,
people’s rights and many others.
Psycho- Social Care of Older Adults: Sexuality and Aging
 As adults aged and changed so does their sexual behavior. Sex may not be the same as it was in
their 20’s, but it can still be fulfilling if sexual health is preserved.
 Older adults who live with their partners can enjoy and maintain a satisfying sexual life through
proper communication.
 Partners should share thoughts on their lovemaking and help each other understand the needs
that have to be met.

Nursing Care of the Older Adult in Chronic Illness

A. Disturbance in Sensory Perception
B. Chronic Confusion
C. Impaired Verbal Communication

Nursing Care of the Older Adult in Chronic Illness

Disturbance in Sensory Perception
Macular degeneration
 Dry macular degeneration is a common eye disorder among people over 50.
 It causes blurred or reduced central vision, due to thinning of the macula. The macula is the part
of the retina responsible for clear vision in your direct line of sight.
Common Clinical Presentation
 Reduced visual acuity
 Loss of central visual field and
 contrast sensitivity
Implications for Rehabilitation
 Difficulty with tasks requiring visual detail such as reading,
 inability to recognize faces, distortion or disappearance of the visual field straight ahead, loss of
color and contrast perception, mobility difficulties related to loss of depth and contrast cues.

Diabetic retinopathy
 Diabetic retinopathy is a diabetes complication that affects eyes.
 It's caused by damage to the blood vessels of the light-sensitive tissue at the back of the eye
(retina).
 At first, diabetic retinopathy might cause no symptoms or only mild vision problems.
Common Clinical Presentation
 Reduced visual acuity
 Scattered central scotomas
 Peripheral and midperipheral Scotomas
 Macular edema
Implications for Rehabilitation
 Difficulty with tasks requiring visual detail such as reading, distorted central vision, fluctuating
vision, loss of color perception, mobility problems resulting from loss of depth and contrast
cues.

Cataract
 Cataracts are the clouding of the lens of the eye, which is normally clear.
 Most cataracts develop slowly over time, causing symptoms such as blurry vision.
  Cataracts can be surgically removed through an outpatient procedure that restores vision in
nearly everyone.

Common Clinical Presentation

 Reduced visual acuity
 Light scatter
 Sensitivity to glare
 Altered color perception
 Loss of contrast sensitivity
 Image distortion
 Possible myopia-
Implications for Rehabilitation
 Usually remedied by lens extraction and implantation, except in extreme cases. If not managed
by replacement.
 Difficulty with detail, bright and changing light, color perception, contrast perception; some
mobility problems caused by loss of perception of depth and distance, sensitivity to glare, loss of
contrast

Glaucoma
Common Clinical Presentation
 Degeneration of optic disc
 Loss of peripheral visual fields

Implications for Rehabilitation

 Mobility and reading problems caused by restricted visual fields, people suddenly appearing in
the visual field seen as “jack-in-the-box.”

Nursing Care of the Older Adult in Chronic Illness

Chronic Confusion
 Chronic confusion, in contrast, is a long-term, progressive, and possibly degenerative process
and occurs over months or years. Both categories can befall in any age group, gender, or clinical
problem
 Chronic confusion is progressive and variable in nature and may usually involve problems with
memory recall, problem-solving, language, and attention.
 Also, there can be difficulties with perception, rationalizing, judgment, abstract thinking,
communication, emotional expression, and the performance of routine tasks.
 Depression, brain infections, tumors, head trauma, multiple sclerosis, abnormalities resulting
from hypertension, diabetes, anemia, endocrine disorders, malnutrition, and vascular disorders
are examples of illnesses that may be linked with chronic confusion.

Impaired Verbal Communication

 Communication with a mentally or physically impaired person can be a difficult and frustrating
task, but good communication skills can prevent catastrophic reactions.
 In dealing with persons with limited physical or mental abilities, it is important to listen, speak
clearly and slowly and use non-verbal communication (body language) to help convey your
message.
  The following article includes tips for communicating with (1) the hearing impaired; (2) the deaf;
(3) the visually impaired; (4) aphasics; and (5) those with Alzheimer's Disease and related
disorders.

Communicating with the hearing impaired

 If the person wears a hearing aid and still has difficulty hearing, check to see if the hearing aid is
in the person’s ear. Also check to see that it is turned on, adjusted and has a working battery. If
these things are fine and the person still has difficulty hearing, find out when he/she last had a
hearing evaluation
 Wait until you are directly in front of the person, you have that individual’s attention and you
are close enough to the person before you begin speaking.
 Be sure that the individual sees you approach, otherwise your presence may startle the person.
Face the hard-of-hearing person directly and be on the same level with him/her whenever possible;
If you are eating, chewing or smoking while talking, your speech will be more difficult to understand;
Keep your hands away from your face while talking;
Recognize that hard-of-hearing people hear and understand less well when they are tired or ill;

Communicating with the deaf

 Communicating with the deaf is similar to communicating with the hearing impaired;
 Write messages if the person can read;
 Use a pictogram grid or other device with illustrations to facilitate communication;
 Be concise with your statements and questions;
 Utilize as many other methods of communication as possible to convey your message (i.e. body
language);
 Spend time with the person, so you are not rushed or under pressure.

Communicating with the visually impaired

 If you are entering a room with someone who is visually impaired, describe the room layout,
other people who are in the room, and what is happening;
 Tell the person if you are leaving. Let him/her know if others will remain in the room or if he/she
will be alone;
 Use whatever vision remains;
 Allow the person to take your arm for guidance;
 When you speak, let the person know whom you are addressing;
 Ask how you may help: increasing the light, reading the menu, describing where things are, or in
some other way.

Communicating with Aphasics

 Aphasia is a total or partial loss of the power to use or understand words. It is often the result of
a stroke or other brain damage. Expressive aphasics are able to understand what you say;
receptive aphasics are not. Some victims may have a bit of both kinds of the impediment.
 For expressive aphasics, trying to speak in like having a word "on the tip of your tongue" and not
being able to call it forth. Some suggestions for communicating with individuals who have
aphasia follow:
 Be patient and allow plenty of time to communicate with a person with aphasia;
 Be honest with the individual. Let him/her know if you can’t quite understand what he/she is
telling you;
  Ask the person how best to communicate. What techniques or devices can be used to aid
communication;
 Allow the aphasic to try to complete his/her thoughts, to struggle with words. Avoid being too
quick to guess what the person is trying to express;
 Encourage the person to write the word he/she is trying to express and read it aloud;

Communicating with persons with Alzheimer’s Disease or related disorders

 Always approach the person from the front, or within his/her line of vision – no surprise
appearances;
 Speak in a normal tone of voice and greet the person as you would anyone else;
 Face the person as you talk to him/her;
 Minimize hand movements that approach the other person;
 Avoid a setting with a lot of sensory stimulation, like a big room where many people may be
sitting or talking, a high-traffic area or a very noisy place
 Maintain eye contact and smile. A frown will convey negative feeling s to a person;
 Be respectful of the person’s personal space and observant of his/her reaction as you move
closer. Maintain a distance of one to one and a half feet initially;
 If a person is a pacer, walk with him/her, in step with him/her while you talk;
 Use distraction if a situation looks like it may get out of hand. A couple of examples are: if the
person is about to hit someone of if he/she is trying to leave the home/facility.
 Use a low-pitched, slow speaking voice which older adults hear best;
 Ask only one question at a time. More than one question will increase confusion;
 Repeat key words if the person does not understand the first time around;
 Nod and smile only if what the person said is understood.