Frequently Asked Questions
Chapter 19: The Older Adult

What are some important points to making when teaching older adults healthy behaviors?

Health teaching for older adults should include smoking cessation; avoiding secondary tobacco smoke; eating a diet low in fat, low in sugar, low in salt, high in protein, high in fruits and vegetables, and high in water; exercising at least 30 minutes for three times a week; expressing emotions appropriately; and avoiding obesity.

What is the difference between the stochastic and nonstochastic biological theories of aging?

Stochastic theories hypothesize that aging occurs randomly and persistently with time, through random error, free radicals, cross-links, “clinkers,” and wear and tear. Nonstochastic theories hypothesize that aging is predetermined through programmed cell changes or through changes in the neuroendocrine or immunologic systems.

What is the difference between disengagement, continuity, and activity theory?

Disengagement theory states that individuals withdraw from society with age and that society withdraws from them. Continuity theory proposes that an individual’s values and personality develop over a lifetime, but goals and individual characteristics remain constant. Activity theory states that an individual’s satisfaction with life depends on involvement in new interests, hobbies, roles, and relationships.

What are the common developmental tasks for older adults?

The common developmental tasks for older adults are: (1) gaining insight or wisdom; (2) developing social skills and same-sex relationships; (3) becoming more open-minded and tolerant; (4) continuing participation in sexual behavior; (5) seeing one’s children transform into responsible, successful adults; (6) becoming a grandparent; (7) holding civic and community positions of responsibility; (8) achieving mastery of one’s occupation or skills; (9) developing new skills, hobbies, and interests; (10) renewing and deepening one’s relationship with one’s spouse, significant others, or friends; (11) gaining new knowledge and experiences; (12) accepting and adjusting to physical changes; (13) coping with aging parents, spouses, and friends; (14) adjusting to the death of a spouse; (15) adapting to major declines in health or physical ability; (16) adjusting to the loss of social role, prestige, occupation, income, or sense of usefulness; (17) getting accustomed to the loss of independent living; (18) adjusting to any kind of loneliness or loss without boredom or depression; and (19) accepting a fixed income.

Which factors influence the rate of aging?

The rate of aging is influenced by genetic composition, lifestyle, previous adaptive responses to stressors, the presence of chronic illnesses, and environmental influences.

What are some of the physiological changes that occur with aging?

• Neurological changes include loss of visual acuity, hearing loss (presbycusis), decreased pain perception, decreases in taste perception and salivation, and decrease in the sense of smell.
• Cardiovascular changes include reduced elasticity of the heart muscle and arteries, arteriosclerosis, thickening of the aortic and mitral values, and decreased cardiac output.
• Respiratory changes include decreased functional respiratory reserve capacity, decreased elasticity and tone of respiratory muscles, fewer functioning alveoli and number of cilia, and calcification of the chest wall and rib cage.
• Gastrointestinal changes include loss of teeth, decrease in saliva and other GI tract juices, decrease in peristalsis, shrinking of the mucosa, decreased absorption of nutrients, and loss of sphincter control.
• Genitourinary changes include loss of muscle tone in the bladder and urethra, decreased bladder capacity, diminished blood flow to the kidneys, and retention of fluids.
• Endocrine changes include slowing of metabolism; alteration in pancreatic activity; and decreased serum growth hormone, estrogen, and testosterone.
• Reproductive changes include inhibition in the number of sperm and in the force of ejaculation in males, and menopause, a decrease in vaginal secretions, and a thinning of the vaginal wall in women.
• Musculoskeletal changes that occur with aging are osteoporosis and kyphosis. Integumentary changes occurring with age are thinning of the layers of skin, dryness of the skin, thickened fingernails and toenails, “age spots,” and photoaging of the skin.

What is the difference between acute confusion and dementia?

Acute confusion is a state of diminished awareness and attention of short duration, usually hours to weeks. Acute confusion involves disorientation to time, place, and person, and tends to worsen at night. Dementia is a chronic confusion, lasting months to years. Older adults with dementia exhibit personality changes, difficulty with sequential speech and thoughts, and lack of orientation to reality

When do changes in roles commonly occur in older adults?

Changes in roles typically occur along with major life events, such as marriage, divorce, birth, death, relocation, and changes in retirement status. Elder abuse is a great concern when working with older adults. Elder abuse consists of physical abuse, neglect, psychological abuse, and exploitation.

Why are older adults at risk for adverse drug reactions?

Drugs are not metabolized or excreted in older adults as well as they are in younger people. Additionally, polypharmacy is more common in older adults because (1) they often accumulate medications, take inappropriate medications, or do not follow prescription instructions; and (2) physicians often overprescribe or prescribe inappropriate medications to older adults.

What should client education on medications include for the older adult?

The nurse must assess the client’s knowledge about the intended effects and side effects of a medication, ability to follow complicated dosing schedules and regimens, ability to pay for the medication, ability to open childproof containers, ability to remember when to take medication, ability to read small print, and need for assistance.

What should the nurse consider during assessment, physical examination, and deriving nursing diagnoses for the older adult?

Assessment should include assessment of the client’s caregiver and home situation. The physical examination should include the effects any physical changes have had on quality of life and activities of daily living. Nursing diagnoses common in older adults are Impaired Physical Mobility, Activity Intolerance, Self-Care Deficit, Social Isolation, Risk for Loneliness, Ineffective Role Performance, Impaired Home Maintenance, and Acute Confusion.

What are common nursing interventions that are helpful when working with older adults?

The common nursing interventions that are helpful when working with older adults are education, communication, life review, health maintenance, support for the client’s psychosocial well-being, promotion of a safe environment, and restorative care.