Chapter 10
The Older Adult Patient
Lesson 10.1
1. Describe the roles of the gerontological nurse.
2. Determine the extent to which selected myths
and stereotypes about older adults are factual.
3. Describe biologic and psychosocial factors
associated with aging.
4. Explain the importance of assessing activities of
daily living and instrumental activities of daily
living.
5. Explain why drug dosage adjustments may be
needed for older persons.
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Definitions of Old Age
Most definitions = having lived a long time
Aging: process of growing older or more
mature
Aging is an ongoing developmental process
that begins at conception and ends in death
Gerontology = study of aging
Geriatrics = biomedical science of old age
and the application of knowledge of aging to
the prevention, diagnosis, treatment, and
care of older persons
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Roles of the Gerontological
Nurse
Typically refers to professional-level nurses
with advanced degrees
Registered nurses who demonstrate
appropriate knowledge and experience can
seek gerontological nurse credentialing
Employment settings for licensed
vocational or practical nurses have shifted
from traditional hospital-based positions to
a range of community-based, long-term
care, and home health care positions
4
Ageism
Systematic stereotyping and
discrimination against people because
of their age
Creates assumptions without assessing
the individual
Allows those who practice ageism to
distance themselves from their own
aging
Influences the behavior of its victims
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Myths About Aging
Cognitive
Social
Intellectual
Sexual
Financial
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Biologic and Physiologic
Factors in Aging
Despite intense interest in longevity by
so many cultures, scientists do not
agree on precisely why or how humans
age
Knowledge of the underlying
mechanisms of aging is critical to
develop a system that considers the
special needs and health conditions of
an aging population
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Theories of Aging
Most experts now believe that aging is
not explainable by a single theory, but
represents many processes working
simultaneously
Most theories of aging fall into three
classifications
Stochastic
Nonstochastic
Evolutionary
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Physiologic Changes of Aging
Nervous system
Respiratory system
Cardiovascular system
Renal system
Integumentary system
Gastrointestinal system
Musculoskeletal system
Sensory system
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Psychosocial Factors
Associated with Aging
Older adults show cumulative
developmental effects that produce
unique personality styles, coping
mechanisms, challenges, and growth
Effective adaptation
Maturity
Erikson’s developmental tasks
Disengagement, activity, and continuity
theories
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Coping and Adaptation
Old age has been described as the
season of losses
Real, threatened, or imaginary losses
are stressors; require adaptation,
flexibility, and resilience to cope
successfully
The older person may cope with these
losses with positive or negative
adaptation
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Coping and Adaptation: Family
Most older adults in the U.S. occupy a variety
of family roles
Marital relations and the relationships between
parent and child seem to be most important
Caregivers frequently report symptoms of
depression, anxiety, helplessness, low morale,
and emotional exhaustion
Education for learning and positive adaptive
behaviors can assist caregivers and recipients
Families must be part of the holistic approach
in the assessment and care of the aged
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Functional Assessment
Activities of daily living; environmental, financial,
family, economic, and community resources
Data useful during times of health, at the onset of
illness, at the beginning of treatment, and
following therapeutic interventions
Knowing what activities an individual performs
alone, what activities require assistance, and what
activities the person is totally unable to perform or
to perform safely is essential to define care needs
The older person’s database should describe both
basic and instrumental activities of daily living
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Drug Therapy and Older Adults
(Slide 1 of 3)
Estimated that 44% of men and 57% of
women 65 years of age and over take
five or more prescription and/or over-
the-counter (OTC) medications each
week
Approximately 12% of both genders
take 10 or more medications each week
Age- and disease-related changes slow
the clearance of drugs, which increases
the risk of adverse effects
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Drug Therapy and Older Adults
(Slide 2 of 3)
Reduction in body size
Decrease in lean body mass and water
content (extracellular volume)
Increase in fat
Serum albumin concentration is lower
A gradual decrease in blood flow to the
internal organs in the abdomen reduces
drug clearance through the liver or
kidney
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Drug Therapy and Older Adults
(Slide 3 of 3)
Risk factors for adverse drug reactions
Age, sex, race (more frequent in older white
females), number of drugs consumed,
dosage, duration of treatment, severity of
illness, and patient cooperation
Symptoms and signs
Restlessness, falls, depression, confusion,
loss of memory, constipation, and urinary
incontinence
Conduct baseline and continual
assessments
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Question 1
Which of the following statements about the
aging nervous system is true?
A. Brain size generally is thought to increase with
age.
B. Aging changes in the nervous system include
decreased conduction speed and increased
activity of the enzymes associated with synaptic
transmission.
C. Extreme impairments in memory and learning are
observed in most people over age 70.
D. Functional ability may not be affected significantly
because reserve cells are able to compensate.
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