HEALTH PROBLEMS:

Injuries, chronic disabling

disease, drug abuse and misuse,
alcoholism, dementia and
mistreatment.
 Increased risk due to:

❑ Changes in vision and hearing.

❑ Loss of mass and strength of
muscle.
❑ Slower reflexes and
reaction time.
❑ Decrease sensory
ability.

INJURIES
 INJURIES
❑ Injury prevention is a major concern for older people.

❑ FALLSare leading cause of morbidity

and mortality among older adults
(Edelman & Mandle, 2010).
❑ Falling once, doubles the chance of falling again.
INJURIES
❑ FIRESare a hazard for the older
adult with failing memory.
 INJURIES
❑ Many older adults suffer and die
from HYPOTHERMIA.
 Make the
environment safe
by identifying and
correcting specific
hazards.
CHRONIC DISABLING ILLNESS
❖ Arthritis
❖Hearing Impairment
❖Cataracts
❖Visual Impairment
❖Hernia
❖Varicose Veins
❖Hypertension
❖Heart Condition
❖Chronic Sinusitis
❖Deformity or Orthopedic Impairment
❖Diabetes
❖Hemorrhoids
 Arthritis
literally means joint inflammation.

Signs and Symptoms:

• Joint pain.
• Stiffness or reduced range of motion.
• Swelling (inflammation).
• Skin discoloration.
• Tenderness or sensitivity to touch around a
joint.
• A feeling of heat or warmth near your joints.
 Diagnosis

MRI and UTZ may help diagnose rheumatoid arthritis in the early stages of
the disease that evaluate the amount of damage in the joints and the severity
of the disease.
Treatment

There is no cure for arthritis. The treatment

goal is to limit pain and inflammation and
preserve joint function.
Treatment options include medicines, weight
reduction, exercise, and surgery.
Synovectomy, joint replacement (arthroplasty), and
joint fusion (arthrodesis).
Hearing Impairment
Age-related hearing loss or presbycusis.

SIGNS and SYMPTOMS:

+ Difficulty hearing other people clearly and

misunderstanding what they say, especially in
noisy places.

+ Asking people to repeat themselves.

DIAGNOSIS:

+ Otoscope- which is a lighted scope,

to check in the outer ear canal and to
look at the ear drum. Looking for
damage to the ear drum, blockage of
the ear canal from foreign objects or
impacted ear wax, inflammation or
infection.
TREATMENT:

+ Hearing aid(s).
+ Assistive devices -telephone amplifiers
or technology that converts speech to
text.
+ Speech-reading (visual cues to
determine what is being said).
 NURSING MANAGEMENT

+ Make sure you have the patient's attention.

+ Use simple and easy-to-understand instructions.
+ Place signage in the room.
+ Help utilize hearing aids.
+ Encourage the use of alternative communication techniques.
 VISUAL
IMPAIRMENTS
Cataract
Cataract is the partial or total opacification
of the lens, usually progressive and
irreversible, leading to loss of vision.

Typically occurring with advancing age, it is

a frequent cause of age-related blindness,
and it is reversible through surgery.
=SIGNS AND SYMPTOMPS=

+ Cloudy or blurry vision.

+ Colors look faded.
+ Can’t see well at night.
+ Lamps, sunlight, or headlights seem too bright.
+ Halo around lights.
+ Seeing double (this sometimes goes away as the cataract gets
bigger).
+ Changing the prescription glasses or contact lenses
often.
DIAGNOSIS

Dilated eye exam. Simple and

painless, the doctor will give some
eye drops to dilate (widen) your
pupil and then check your eyes for
cataracts and other eye problems.

If you're age 60 or older, get a

dilated eye exam once every 1 to 2
years.
Treatment
Surgery is the only
way to treat
cataracts, but you
may not need it
right away.
•Phacoemulsification.
•Extracapsular cataract extraction (ECCE).
•Femtosecond laser-assisted cataract surgery (FLACS).
NURSING MANAGEMENT

+ Check visual acuity.

+ Teach patient about cataracts and their treatment.
+ Teach patient about healthy diet.
+ Educate about medication compliance.
+ Help them find ways to limit their driving.
+ Encourage them to stay as healthy as possible.
+ Find out if cataract surgery is a possibility.
+ Make sure they attend their yearly medical and vision exams.
Age-related
Macular
Degeneration
Age-related Macular Degeneration
An eye disease that can blur central vision.
It happens when aging causes damage to the macula
— the part of the eye that controls sharp, straight-ahead
vision.

The disease is most common in people over age 60.

 Does not involve
abnormal blood vessels.
Abnormal blood vessels form in the eye
that leak proteins and lipids.
It is more common
and less severe.
+ Blurry or fuzzy vision. Signs and Symptoms
+ Difficulty recognizing familiar faces.

+ Straight lines appear wavy.

+A dark, empty area or blind spot

appears in the center of vision.

+Loss of central vision, which is

necessary for driving, reading,
recognizing faces and performing
close-up work.
Diagnosis
Laser Ophthalmoscope Microperimetry - It is a useful
device in scanning and grading focal retinal sensitivity in
patients with dry age-related macular degeneration

Fluorescein angiography - to diagnose or monitor eye

conditions that affect the blood vessels in your retina.
OCT-Non-invasive diagnostic technique that renders
an in vivo cross-sectional view of the retina. Utilizing
interferometry to create a cross-sectional map of
the retina.

Amsler Grid- printed on paper or a magnet (that can

be placed on your refrigerator) and is given to the
patient to take home as a tool to track quality of
vision at home. The grid will show symptoms of
AMD if the center of the grid appears wavy or
absent.
 Doctor will give some eye drops to dilate (widen) your
pupil and then check your eyes for AMD and other
eye problems.

A test to measure the pressure inside your eyes.

 Treatment
There is no treatment, but vision aids can help
reduce the effect on your life.

There is no cure for wet AMD .

Treated with injections of angiogenesis inhibitors into the
eye, photodynamic therapy (PDT), or laser surgery, which all
slow the growth of new, fragile, and often leaky blood
vessels. This effect may slow the rate of vision decline or
stop further vision loss.
Photodynamic therapy uses a laser and a special
medicine (photosensitizer) that works when exposed
to a certain type of light to destroy cancerous and
precancerous cells after light activation.
Photosensitizers are activated by a specific wavelength
of light energy, usually from a laser.

Laser photocoagulation is eye surgery using a

laser to shrink or destroy abnormal structures in
the retina, or to intentionally cause scarring.
Anti–vascular Endothelial Growth Factor
- Anti-VEGF drugs, may help stop the growth of new blood
vessels. These medicines block the effects of vascular
endothelial growth that signals the body sends to
generate new blood vessels. They are considered the first
line treatment for all stages of wet macular degeneration.

AREDS2 supplement to slow the progression of AMD

Syfovre (pegcetacoplan) and Izervay (avacincaptad pegol)
They are administered through eye injection.
Nursing
+ Providing low-vision aids.
Management
+ Promoting adequate lighting.
+ Referring patients to vision rehabilitation services.
+ Supportive lifestyle changes to adapt to the decrease in
vision and others.
+ Vitamin supplements delay the progression of AMD.
Vitamins A, C and E - Carotenoids are naturally occurring pigments
in fruits and vegetables that give them a red, green or yellow color,
and are also effective against oxidants.
 Diabetic
Retinopathy

Caused by high blood sugar that can

damage the retina.
 Signs and symptoms

+ Gradually worsening vision.

+ Sudden vision loss.

+ Shapes floating in your field of

vision (floaters).

+ Blurred or patchy vision.

 DIAGNOSIS
The eye doctor may do the following tests, as well as a complete
health history and eye exam, to diagnose diabetic retinopathy:

+ Visual acuity test.

+ Ophthalmoscopy.
+ Tonometry.
+ Optical coherence tomography.
+ Pupil dilation.
+ Dilated eye exam.
+ Fluorescein angiography.
Treatment There is no cure.

This procedure uses a tiny incision in the eye to

remove blood from the middle of the eye
(vitreous) as well as scar tissue that's tugging on
the retina.
Laser surgery can repair a retinal tear or hole.
Using a laser to heat small pinpoints on the
retina. This creates scarring that usually binds
(welds) the retina to the underlying tissue.
Immediate laser treatment of a new retinal
tear can decrease the chance of it causing a
retinal detachment.
Gene therapy which involves the insertion of
healthy genes into the retina to replace faulty
ones responsible for developing diabetic
retinopathy.
Intravitreal injection of anti-VEGF agents for
diabetic macular edema faricimab-svoa (Vabysmo),
ranibizumab (Lucentis) and aflibercept (Eylea).
 NURSING MANAGEMENT
•Assess the vision ability and degree of visual impairment.
•Monitor blood sugar levels regularly.
•Encourage the patient to have regular checkups with an ophthalmologist as
recommended.
•Create a daily routine for the patient, as consistent as possible.
•Encourage the patient to promote sufficient lighting at home.
•Administer medications for diabetic retinopathy as prescribed.
•Encourage the patient to use low vision aides.
•Educate the patient for the need to monitor and report any visual disturbances or
other sensory changes.
•Place the bed in the lowest position.
•Place the call bell within reach and keep the visual aids, and patient’s phone and
other devices within reach.
•Ensure that the floor is free of objects that can cause the patient to slip or fall.
•Advise the patient to wear sunglasses especially when going outdoors.
GLAUCOMA

GLAUCOMA
Is a group of eye diseases that can cause
vision loss and blindness by damaging a
nerve in the back of your eye called the
optic nerve.
Open-angle glaucoma
most common type of glaucoma.
There is something wrong with the
drainage angle where the iris meets
a tissue called the trabecular
meshwork of the eye. It may
appear to be open and appears
normal in microscopic exams.
Closed-angle glaucoma
or narrow-angle glaucoma
A mechanical problem exists with
the drainage angle of the eye. This
means the iris is too close to the
trabecular meshwork. This causes
blockage of the drainage angle that
prevents fluid from being properly
drained from the eye.
SIGNS and SYMPTOMS

+ Sudden, severe pain in one

eye.
+ Decreased or cloudy vision,
often called "steamy" vision.
+ Nausea and vomiting.
+ Rainbow-like halos
around lights.
+ Red eye.
+ Eye feels swollen.
DIAGNOSIS Comprehensive dilated eye exam.
simple and painless, some eye drops to dilate
(widen) your pupil and then check the eyes for
glaucoma and other eye problems. The exam
includes a visual field test to check your side vision.
 There's no cure for glaucoma, but early treatment can
TREATMENT often stop the damage and protect your vision.

Trabeculectomy - most common type of surgery that

involves removing part of the eye-drainage tubes to
allow fluid to drain more easily. It may be carried
out under local or general anesthetic.

Laser therapy is a safe and effective alternative to

eyedrops as a first-line treatment for patients with
newly diagnosed primary open-angle glaucoma.
TREATMENT
Eyedrops are the main treatment for
glaucoma by reducing the pressure in the
eyes.
Prostaglandin analogues also known as
hypotensive lipids; PGAs are the first drugs of
choice in the medical management of
glaucoma.

Examples: latanoprost (Xalatan), travoprost

(Travatan Z), bimatoprost (Lumigan) , and
unoprostone isopropyl (Vyzulta).
 NURSING INTERVENTIONS

+ Recognize and assess signs and symptoms of

glaucoma.

+ Monitor intraocular pressure and optic nerve

function.

+ Administer prescribed medications, such as eye

drops, to manage intraocular pressure.

+ Avoid Falls and Accidents.

Varicose Veins
Are swollen, twisted vein that
lie just under the skin.

Aging causes wear and tear on the

valves in the veins that help control
blood flow. Over time, that wear
causes the valves to allow some
blood to flow back into the veins,
where it collects. This pooling leads
to painful swollen, tangled veins on
the legs and feet.
 SIGNS and SYMPTOMS
+ Bulging, bluish veins.
+ Itching or burning discomfort around the veins.
+ Skin color changes around the veins.
+ Swelling in the legs.
+ Aching pain in the legs.
+ A feeling of heaviness in the legs and feet.
+ Nighttime leg cramps
 DIAGNOSIS

Clinical evaluation of swelling,

discoloration, skin ulcerations, and
symptoms associated with varicose
veins include leg heaviness and
itching.
 DIAGNOSIS
In most cases, a test called a duplex
ultrasound scan will be carried out.
This is a type of scan that uses
high-frequency sound waves to
produce a picture of the veins in
the legs. The picture shows the
blood flow and helps the vascular
specialist locate any damaged
valves that might be causing your
varicose veins.
 Elevation of the legs it allows
the blood to circulate back to the
heart without fighting gravity.

Compression stockings to apply pressure

to lower legs, helping to maintain blood
flow and reduce discomfort and swelling.
It’s not a cure , but it can help to control
the symptoms and may prevent the
condition from getting worse. TREATMENT
 TREATMENT
Sclerotherapy involves injecting a
chemical solution directly into the
varicose or spider vein. The
solution causes the vein walls to
swell, stick together and seal shut,
stopping the flow of blood. As a
result, the vein fades within a few
weeks.
 TREATMENT
Endovenous thermal ablation
is a procedure where controlled
heat is used to seal varicose
veins. Destruction of tissue by
extreme hyperthermia or
hypothermia.
 TREATMENT

Phlebectomy is a minimally
Microphlebectomy to remove invasive
varicosesurgical
veins procedure
through
small,
to remove
slit-like
surface
incisions
varicose
in the
veins.
skin.ItThis
hasminimally
been referred
invasive
to as an “ambulatory
treatment does phlebectomy”
not require because
sutures or the
general
anesthesia
patient is typically
and canable
easily
to be
walk
performed
immediatelyin doctor's
after the
office with minimal downtime.
procedure.
TREATMENT
Catheter-based procedures using
radiofrequency or laser energy.
This procedure is the treatment most
used for larger varicose veins. The
catheter is guided into the vein to be
treated using ultrasound imaging.
Radiofrequency or laser energy heats
the tip of the catheter. As the catheter is
pulled out, the heat causes the vein to
collapse and eventually heal shut.
TREATMENT
Endovenous laser ablation therapy
(EVLT)
is a minimally invasive procedure that
makes use of catheters, lasers, and
ultrasound to stops the blood flowing
from veins that cause enlarged
varicose veins. This procedure is
performed most often on veins that
are still relatively straight and
untwisted.
 Vein Litigation and Stripping
Is a minor surgery and old method of
treating varicose veins.
It is used to remove a damaged vein and
prevent complications of vein damage.
If several valves in a vein and the vein
itself are heavily damaged, the vein (or
the diseased part of the vein) is removed
(stripped).

TREATMENT
 NURSING INTERVENTIONS
+ Elevation may improve symptoms in some patients.
+ Avoidance of prolonged sitting and standing.
+ Loosening of restrictive clothing. Pick out a comfortable pair of shoes.
+ Modification of cardiovascular risk factors, and reduction of peripheral
edema.
+ Weight loss may improve symptoms in patients who are obese.
+ Wear compression stockings as part of your work wardrobe.
 NURSING INTERVENTIONS
+ Flex the ankles.
+ Exercise and eat right.
+ Get treatment.
+ Restore skin integrity.
+ Promote rest.
+ Improve physical mobility.
+ Improve circulation.
+ Relieving discomfort.
+ Avoid complications .
Vascular massage therapy will
only make them feel better
temporarily is not an effective
varicose vein treatment.
Putting pressure on varicose veins
heightens the risk of a rupture.
It's possible for a blood clot to be
dislodged during a massage.
High Blood Pressure HYPERTENSION
is when the pressure in
your blood vessels is too
high (140/90 mmHg or
higher). It is common but
can be serious if not
treated.
 For most adults, there's no identifiable cause of high blood
pressure. This type of high blood pressure is called primary
hypertension or essential hypertension. It tends to develop
gradually over many years. Plaque buildup in the arteries, called
atherosclerosis, increases the risk of high blood pressure.
Things that increase the People with high blood
risk of having high blood pressure may not feel
symptoms. The only way to
pressure include:
know is to get your blood
pressure checked.
•older age
•genetics
•being overweight or obese
•not being physically active
•high-salt diet
•drinking too much
alcohol
Heart disease is the leading
cause of death for African
American.
Chronic Sinusitis
is persistent sinus swelling that
interferes with the way the mucus
drains, making it difficult to breathe
through the nose.

When the sinuses are chronically

inflamed, they trap mucus, making your
sinuses more susceptible to bacteria
growth and infection.
Chronic Sinusitis
Poorer blood circulation to the nasal lining.

Less humidification of the air passing

through the nose.

Nasal dryness.

Furthermore, in the elderly, the

clearance of the mucus from the
nose is less efficient.
People over the age of 65 often
suffer from chronic sinus issues.
1.Congestion or “fullness” in
the face
2.Blockage in one or both
nasal passages
3.Fever
4.Runny nose
5.Discolored postnasal
drainage (drainage at the
back of the throat)
6.Pus in the nasal cavity
7. Headaches
8. Fatigue
9. Ear pain
10. Aching upper jaw and
teeth
11. Cough or throat clearing
12. Sore throat
13. Bad breath
 DIAGNOSIS
Chronic sinusitis is diagnosed when at least
Purulent Drainage two of the following four symptoms are
present and occur for more than 12 weeks.

TREATMENT
To reduce nasal obstruction, increase sinus
ostia size, promote improved mucociliary
function, decrease mucosal inflammation and
Nasal Obstruction thin secretions.
✓ Steam and nasal saline irrigation or saline rinse.
✓ Decongestants.
✓ Nasal Sprays
Hyposmia ✓ Analgesics
✓ Topical corticosteroids
✓ Antibiotics
✓ Mucoevacuants
Facial/Dental Pain ✓ Endoscopic sinus surgery or balloon sinuplasty.
 Deformity
or
Orthopedic
Impairment
 Arthritis is the swelling and tenderness of one or more joints. Symptoms worsen with age.
The cause of some forms is unknown, but arthritis can also be the result of disease, infection, genetic defect,
injury, or overuse.

Signs and Symptoms:

✓ pain.
✓swelling.
✓redness and warmth.
✓stiffness.
✓reduced movement.

Autoimmune Degenerative

Cartilage Loss Inflamed Synovium

Asymmetrical Symmetrical

Morning Stiffness lasting less than 1 hour Morning Stiffness lasting more than 1 hour
Osteoporosis
Causes bones to become weak and brittle
that a fall or even mild stresses such as
bending over, or coughing can cause a
break. Breaks most commonly occur in
the hip, wrist or spine.

Signs and Symptoms

Diagnosis Risk Factors
Bone Density Scan. ✓ Age
Used to measure bone mineral density (BMD).
It is most commonly performed using dual-energy x-ray ✓ Body size
absorptiometry (DXA or DEXA) or bone densitometry.
✓ Changes to hormones
✓ Diet
Treatment ✓ Race
Hormone Therapies
✓ Family history
Like replacement estrogen or testosterone Bisphosphonates — ✓ Medications
that slow the breakdown and removal of bone (resorption).
They are widely used for the prevention and treatment of
✓ Lifestyle
osteoporosis in postmenopausal women. ✓ Sex
There is no cure for osteoporosis.
Geriatric fractures
Bones have become more brittle because of
age or have been weakened by conditions
like osteoporosis or cancer.

Falls and car accidents are major causes of

geriatric fractures, though they can also
happen when a repetitive motion has tired
muscles, allowing more pressure on the
bone.
Kyphosis
An increased front-to-back curve of the spine.
Kyphosis is an exaggerated, forward rounding of Treatment
the upper back. Exercise, combined with good posture and
Cause chiropractic care.
Weakness in the spinal bones that causes them to
compress or crack.
Diagnosis
An X-ray can usually confirm the diagnosis and
determine the cause of the kyphosis.
Prevention
Practicing proper posture.
Engaging in exercises to strengthen the back and neck.
Lighten the load, this will give your spine a break.
Hallux valgus
also known as a bunion.
manifests with the proximal phalanx deviating
laterally and the first metatarsal head deviating
medially and due to the abduction of the first
metatarsus, called metatarsus primus varus.
Cause
Wearing tight, narrow shoes might cause
bunions or make them worse.
As a result of the shape of your foot, a
foot deformity or a medical condition,
such as arthritis.
Hammertoe or
Mallet toe
Happen when something puts pressure on toes
and pushes them out of place. Over time,
muscles and tendons in toes tighten, freezing
the toes in a curled shape.
Cause
✓ Unknown.
✓ Wearing short, narrow shoes that are too tight.
✓ High-arched feet.
✓ Foot injury and certain diseases like diabetes and
arthritis.
✓ Second toe is longer than your big toe
TREATMENT
If become stiff, painful and limit activity, surgery may
be warranted (Digital arthroplasty).
 ClAW TOES
Older toes have a propensity toward curling
into "claw toes" because of muscle imbalance.
Older women are prone to develop.
Claw toe gets worse without treatment and
may become a permanent deformity over time.

Cause
✓ Unknown in many cases. PREVENTION
✓ Congenital.
1. Shoes that have roomy toe boxes.
✓ Signs of arthritis
2. Low heels and good arch support.
✓ Nerve problem in legs or
3. Shoes with an increased width and depth.
spinal cord.
4. Shoes with soft soles and minimal seams in the toe box.
✓ Weakened muscle due to
5. Wearing pads, arch supports or other shoe inserts to
DM and alcoholism.
cushion the toe.
 Morton’S NEUROMA
Thickening of the tissue around one of the nerves leading to
the toes. This can cause a sharp, burning pain in the ball of
the foot if left untreated.
Cause Symptoms
✓ Pain in the front part of the
✓ Unknown in many cases.
foot.
✓ Chronic nerve stress and
✓ Feeling like walking on a rock or
irritation.
a marble.
✓ Excessive toe dorsiflexion
✓ Stinging, burning or numbness
✓ Poorly fitting and
in affected toes.
constricting shoes or shoes
with heels. Treatment
✓ Switching footwear.
RISK FACTOR ✓ Shoe pads.
✓ More often in older ✓ Massage.
women. ✓ Surgery (neurectomy)
Age Associated
Age Associated
nailDisorders
Nail Disorders
 Onychogryphosis

Pachyonychia

Trachyonychia Onychauxis

Splinter
hemorrhage

Onychophosis Onychocryptosis Onycholysis

 Subungual Brittle Nail Onychomycosis
exostosis Syndrome

Subungual
hematoma
Longitudinal
Nail psoriasis melanonychia
Paronychia

Beau’s lines
 Retronychia

Onychomadesis
Diabetes Mellitus
Hemorrhoids
 Hemorrhoids
(piles)
45-65 years old.
Body ages and grows weaker.
More sedentary lifestyle.

Blood that flows to the lower part of the body

slows down.
Increased pressure can cause sagging of blood
vessels around the rectum and anus.

Hypervascularization.
Strained and prolonged defecation.
Chronic constipation.
 Disabling Illnesses
Having an illness persisting for a long time
or constantly recurring.
Examples: Cancer, Heart disease, Arthritis, Stroke and Diabetes
Many older adults function well within
the community without impairments;
others are afflicted with one or more
chronic illnesses that may seriously
impair functioning.

Chronic illness brings many changes to

the client and the family members.
Client: may need increasing help with
ADLs of ambulation, feeding, hygiene.

Family: health care expenses often

escalate and become an economic
concern, family roles may be
altered, and family members may
need to change lifestyle to meet
caregiving needs.
 Drug Abuse and Misuse

Older adults take an average of 31.1 prescriptions per year (Mauk, 2014).

Added to this, they may purchase OTC drugs to remedy discomforts related
to aging such as constipation, sleep disturbance and joint pain.
Self-administration may lead to a variety of misuse
situations:

o Taking too much or too little medication.

o Combining alcohol and medications.
o Combining prescribed medications with OTC.
drugs causing increased risk for drug interactions
and adverse events.
o Taking meds at a wrong time.
o Taking someone else’s medication.
o When more than 1 primary care provider.
prescribes meds and client fails to tell each
primary care provider has previously prescribed.
POLYPHARMACY
Simultaneous use of drugs by a single patient
for one or more conditions (multidrug
therapy/regimen).

Safe medication-taking behaviors:

❑ List all medications.

❑ Know reason why you are taking the meds.
❑ Use a pill organizer.
❑ Ask pharmacist for easy-to-open containers
if having difficulty opening the meds.
❑ Obtain all meds from the same pharmacy to
monitor drug interactions and duplications.
MISTREATMENT OF OLDER ADULTS
Approximately 1 to 2 million Americans over the
age of 65 has been abused, neglected, or exploited
by someone on whom they have depended for
protection and care.
– National Council on Child Abuse and Family Violence, 2014
MISTREATMENT OF
OLDER ADULTS
❑ 10% of adults 60 or older who live in
community are abused ( Lachs and
Pillimer, 2015).
❑ Adult children and spouses are
perpetrators.
o Who are male, have history of
substance abuse, have mental or
physical health issues, have run-ins
with police, live socially isolated, have
financial problems, and reported
increase stress.
o Victims are women, young-old, lower
income or isolated, and lack social
support.
❑ Mistreatment of older may affect
either gender (mostly are women of
75 years of age).

❑ Abuse may be physical,

psychological or emotional in
nature.

Examples: sexual abuse, financial abuse

, violation of human rights, active or
passive neglect.
PHYSICAL ABUSE
o Intentional physical force.
o Physical injury.
o Inflicting pain from discomfort to
agony.
o Functional impairment.
o Physical suffering.
o Death.
o Inappropriate use of medication.
o Inappropriate use of physical
restraints.
o Physical punishment.
EMOTIONAL OR PSYCHOLOGICAL ABUSE
o Verbal and non-verbal inflicting
anguish, mental pain, fear or distress.
o Humiliation and disrespect, threats,
harassment and isolation or coercive
control.

SEXUAL ABUSE
o Force or unwanted sexual
interaction.
o Touching and non-touching act
(photography, voyeurism. Verbal and
non-verbal harassment, force viewing
of pornographic materials).
 FINANCIAL ABUSE NEGLECT
o Illegal, improper, unauthorized use of
o Failure to protect an elder
resources to benefit someone other
from harm, failure to meet
than older adult.
the essential medical care,
nutrition and hydration, ADL
or shelter that results in
serious risk of compromise
health or safe.
 ALCOHOLISM
2 types of older alcoholics:
1. those who began drinking alcohol in their youth.
2. those who began excessive alcohol use later in life to help them cope with the
changes and problems of their older years.
❑Approximately one third of
older alcoholics are late onset
drinkers (after age 60) and that
number includes a higher
number includes women
(Ebersole et al 2012).

❑Chronic drinking has major

effects on all body systems:
progressive liver and kidney
damage, damages the stomach
and other related organs, slow
mental responses leading to
injuries and death.
❑ Alcohol interacts with various
drugs, altering the normal
effect of the medication to on
the body:

Examples:
o Anticoagulants and narcotics - increased effect when taken with alcohol
o Antibiotics – inhibits action
▪ For an older adult who has chronic illness, takes many meds, the combination
of drugs and alcohol can lead to serious drug overdose
 NURSING MANAGEMENT
❑Clients with alcoholism should not be stereotyped or
prejudged by the nurse.

❑The nurse should assess the number and type of

alcoholic beverages consumed as well as the pattern
and frequency of consumption.

❑Discuss any meds the client is taking and its side

effects and interaction effects of alcohol and meds.

❑To facilitate the treatment of the drinking problem in

addition to the prevention of possible complications.
(Nurse advocate)
 DEMENTIA
DELERIUM
DEPRESSION
3Ds
DEMENTIA
❑ a progressive loss of cognitive function.
❑ Most common type is the Alzheimer’s disease, wherein cause is unknown
❑ Course of the disease is slow and insidious (gradual).
❑ Symptoms vary from client to client, prominent symptoms are cognitive
dysfunctions: decline in memory, learning, attention, judgment,
orientation and language skills.
❑ Sundowning syndrome-confused, restless, agitated after dark.
❑ Wandering may occur, coping up with hallucination, delusion and paranoia.
❑ Symptoms are progressive leading to a steady decline in cognitive and
physical abilities lasting in 7 to 15 years ending in death.
❑ No cure or specific treatment for AD, several drugs has been developed
but none has been shown consistently to reverse the progression of the
disease.
❑ Communication with
family members and
DEMENTIA
systematic approach to
assessment is required.

❑ The tool proved effective in

identifying common
problems experienced in
older adult that can lead to
negative outcome.

❑It assist in preventing and

detecting common
complications.

❑This can be used in many settings and alerts nurses to quickly identify
interventions to individualize an older adult’s care.
DELERIUM
❑ Temporary state of confusion.
❑ Acute illness with specific underlying cause.
❑ May last from hours to weeks and resolved with treatment of cause.
❑ May cause by drug interactions, circulatory or metabolic problems,
nutritional deficiencies, worsening illness triggering inflammatory process
and disrupts neurotransmitters.
❑ Manage through prevention, as it is triggered by sleep deprivation,
immobility, visual or hearing impairment, and dehydration (
Wan7Chase,2017).
❑ Preventive measures includes reorientation after surgery, ensure glasses
and hearing aids at bedside.
DEPRESSION
❑ Extreme prolonged sadness is a warning sign.
❑ Death of spouse or friends and changes in living environment and financial
resources can precipitate feelings of grieving, left unresolved.
❑ Signs may include, sleep disturbance, weight loss or gain, difficulty
concentrating, irritability or anger, loss of interest in pleasurable activities,
vague pains, crying, fatigue and suicidal thoughts or preoccupation with
death.
❑ 7% of older adult world-wide is underdiagnosed and untreated
(WHO,2016).
❑ Treatment includes, psychotherapy or counseling along with
antidepressant medication.
❑ Hopelessness rather than sadness is more often associated with suicidal
intent.
Nursing Responsibilities:

❑ Provide supportive care and accurate information.

❑ Referral assistance when placement in a nursing facility is

deemed necessary.

❑ Ongoing assessment to both the client and caregiver is

important especially if the client’s condition deteriorates.
 #rciconnects

Riverside College, Inc. - RiversideCollegeBcd RiversideCollegeBcd

Bacolod City