Care of the Older or Disabled Adult



Care of the Older or Disabled Adult





OVERVIEW AND ASSESSMENT

A comprehensive geriatric evaluation (CGE) is essential to fully understand the health needs of older adults. The CGE is performed by a multidisciplinary team, which typically includes a geriatric nurse, geriatric physician, and social worker. Other members of the team may include a pharmacist, physical therapist, and dietitian. The Hartford Institute for Geriatric Nursing provides many tools for assessment of older adults on their Web site (www. consultgerirn. org/resources).


Normal Changes of Aging

There are a number of normal age-related changes that occur in all major systems of the body. These may present at different times for different people. It is important to be able to differentiate between normal and abnormal changes in older adults and to educate patients and families about these differences.


Vision



Assessment Findings



  • Arcus senilis—deposits of lipid around the eye, seen as a white circle around the iris; causes no vision impairments.


  • Cataracts—clouding of the normally clear lens of the eye. (This results in lens thickening and decreased permeability; noted on examination with an ophthalmoscope; fuzziness of vision, like looking through wax paper. Cataracts cause blurring, sensitivity to light, and/or double vision.)


  • Macular degeneration—due to damage to macula that results in loss of central vision. (Objects seem blurred, distorted, or are not seen.)


  • Glaucoma—increased intraocular pressure with tonometer testing. (Results in blurring, colored “halos” around lights, pain or redness of eyes, loss of peripheral vision.)


  • Smaller pupil size.


  • Complaints of decreased ability to read, discomfort from light, changes in depth perception, falls, collisions, difficulty handling small objects, difficulty with activities of daily living (ADLs), and tunnel vision.


  • Dry, red eyes.


  • Vitreous floaters, which are lightning flashes in the visual field.



Nursing Considerations and Teaching Points



  • Make sure objects are in the patient’s visual field, and do not move objects around.


  • Use large lettering to label medications and any distributed written information.


  • Allow the person more time to focus and adjust to the environment.


  • Avoid glare—may help to wear sunglasses.


  • Use nightlights to help with dark adaptation problems.


  • Use red and yellow to stimulate vision.


  • Mark the edges of stairs and curbs to help with depth perception problems.


  • Use microspiral telescopes or magnifying glasses and highintensity lighting.


  • Encourage yearly eye examination and/or refer for examination if vision changes worsen (flashing lights in fields or “veil over the eye”).


  • Encourage use of isotonic eyedrops as needed for dry eyes.


  • Encourage use of low vision aids, such as magnifying lens, light filtering lens, telescopic lenses, or electronic devices.


  • Refer patients to the following resources for vision impairments:



    • Prevent Blindness America 800-331-2020

      www.preventblindness.org


    • American Foundation for the Blind 800-232-5463

      www.afb.org


    • American Council of the Blind 800-242-8666

      www.acb.org


    • National Institutes of Health Low Vision & Blindness Educational Resources

      http://health.nih.gov/topic/LowVisionBlindness


Hearing



Assessment Findings



  • Increased volume of patient’s own speech.


  • Turning of head toward speaker.


  • Requests of a speaker to repeat.


  • Inappropriate answers, but otherwise cognitively intact.


  • The person may withdraw, demonstrate a short attention span, and become frustrated, angry, and depressed.


  • Lack of response to a loud noise.


Nursing Considerations and Teaching Points



  • Be aware that hearing loss can impact the safety and quality of life for older adults in many ways. For example, the older adult may not hear instructions, alerting signals, telephones, or oncoming traffic. Hearing loss can contribute to social isolation and lower self-esteem.


  • Suggest hearing testing with an audiologist for further evaluation and consideration of an assistive device.


  • Face the person directly so he can lip-read.


  • Use gestures and objects to help with verbal communication. 5 Touch the person to get his or her attention before talking.


  • Speak into the patient’s “good ear.”


  • Do not shout. Shouting increases the tone of the voice, and older adults are unable to hear these high tones. Try speaking in a deeper or lower tone of voice.


  • Speak slowly and clearly.


  • Suggest amplifiers on telephones and alarms.


  • Allow the person more time to answer your questions.


  • Evaluate the person’s ear canals regularly and assist with cerumen removal. Cerumen removal is facilitated by:



    • Use of ceruminolytic agents, such as carbamide peroxide, 10 drops in the affected ear twice per day for 5 days, followed by flushing the ear with warm water via a 50-mL irrigation syringe or an electronic irrigation device.


    • Careful use of an ear spoon to mechanically remove cerumen.


  • Refer patients to the following organizations:



    • American Speech—Language—Hearing Association: www.αshα.org


    • HearingLoss.com: www.hearingloss.com


    • National Institute on Deafness and Other Communication Disorders: www.nidcd.nih.gov/health/hearing/pages/older.aspx



Smell



Assessment Findings



  • Inability to notice unpleasant odors, such as fire, body odor, or excessive perfume.


  • Decreased appetite.


Nursing Considerations and Teaching Points



  • Age-related changes can impact safety and quality of life. For example, an older individual may not be able to recognize the smell of smoke or gas.


  • The inability to smell food may cause a decrease in the consumption of nutritious food.



    • At mealtimes, name food items and give the person time to think of the smell/taste of the food.


    • Suggest use of stronger spices and flavorings to stimulate sense of smell.


Taste



Assessment Findings



  • Complaints that food has no taste.


  • Excessive use of sugar and salt.


  • Inability to identify foods.


  • Decrease in appetite and weight loss.


  • Decreased pleasure from food.


Nursing Considerations and Teaching Points



  • Age-related changes can impact safety. For example, the older individual may not be able to detect spoiled food.


  • Serve food attractively, and separate different types of foods.


  • Vary the texture of foods.


  • Encourage good oral hygiene.


  • Season food.


Kinesthetic Sense



Assessment Findings



  • Alterations in posture, ability to transfer, and gait


  • Complaint of dizziness


Nursing Considerations and Teaching Points



  • Position items within reach.


  • Give person more time to move.


  • Take precautions to prevent falls.


  • Suggest physical therapy with balance training after periods of prolonged immobility.


Cardiovascular



Assessment Findings



  • Normal blood pressure (BP) is less than 120/80 mm Hg; prehypertension, 120 to 139/80 to 89; stage 1 hypertension, 140 to 159/90 to 99; stage 2 hypertension, 160/100 mm Hg and greater.


  • Prolonged tachycardia may occur following stress.


Nursing Considerations and Teaching Points



  • Encourage regular BP evaluation as well as lifestyle modifications and medication adherence, if indicated, for hypertension.


  • Check for postural BP changes to detect orthostatic hypotension and prevent falls. Instruct patients to rise slowly from lying to sitting to standing.


  • Encourage longer cool-down period after exercise to return to baseline cardiac function.


  • Encourage moderate physical activity: walking, biking, or swimming for 30 minutes five times per week (150 minutes per week), in addition to muscle strengthening exercises two times a week.


Pulmonary




Assessment Findings



  • Prolonged cough, inability to raise secretions.


  • Increased frequency of respiratory infections.


Nursing Considerations and Teaching Points



  • Older adults who are undergoing surgical treatment should engage in deep-breathing exercises.


  • Teach measures to prevent pulmonary infections—avoid crowds during cold and flu season, wash hands frequently, report early signs of infection.


  • Avoid smoking and exposure to secondhand smoke.


  • Encourage annual flu vaccine and pneumonia vaccine at age 65 or as needed.


Immunologic



Assessment Findings



  • More frequent infections.


  • Increased incidence of many types of cancer.


Nursing Considerations and Teaching Points



  • Teach older adults that they are at increased risk of infection, cancer, and autoimmune disease; therefore, routine follow-up and screening are essential.


  • Encourage healthy lifestyle practices to maintain optimal health.


Neurologic



Assessment Findings



  • Decreased position and vibration sense.


  • Diminished reflexes, possible absent ankle jerks.


  • Complaint of falls and impaired balance.


  • Wide-based gait with decreased arm swing.


Nursing Considerations and Teaching Points



  • Because of these changes in combination with sensory changes, it is essential to teach older adults fall-prevention techniques.



    • Environmental safety techniques include nonslip surfaces, securely fastened handrails, sufficient light, glare-free lights, avoidance of low-lying objects, chairs of the proper height with armrests, skidproof strips or mats in the tub or shower, toilet and tub grab bars, elevated toilet seats.


    • Home safety evaluations should be done on all communitydwelling older adults to reduce the risk of falls. A home safety checklist can be obtained from the National Safety Council at www.nsc.org.


Musculoskeletal



Assessment Findings



  • Muscle atrophy.


  • Increased incidence of fractures.


  • Complaint of joint stiffness in absence of arthritis.


  • Decreased bone density (less than 2.5 standard deviations below normal).


Nursing Considerations and Teaching Points



  • Early intervention to encourage regular exercise (including weight-bearing exercise and resistance training) in older adults is important to prevent exacerbation of these normal changes.


  • Encourage increased intake of calcium and vitamin D and decreased alcohol and nicotine use.


Community and Home Care Considerations



  • Encourage older adults to engage in 30 minutes of moderate physical activity, including walking, biking, or swimming, at least five times per week, in addition to muscle strengthening exercises at least two times a week.


  • For older adults who will be exercising at less than 80% of the maximum heart rate (220 — age), stress testing before starting an exercise program is not needed.


  • To help with adherence to the exercise program, older adults should be encouraged to exercise at a set time, to relieve pain before exercising, and to do an activity they enjoy. Provide positive reinforcement for those who do exercise, and continually reinforce the benefits of exercise (increased bone strength, cardiovascular fitness, decreased risks of falls, overall sense of well-being).


Endocrine




Assessment Findings

Usually asymptomatic.


Nursing Considerations and Teaching Points



  • Encourage routine screening for elevated blood glucose— both fasting and postprandial.


  • Provide education about a well-balanced diet.


Reproductive



Assessment Findings



  • Vaginal dryness, painful intercourse.


  • Atrophic vaginitis.


  • Urinary incontinence.


Nursing Considerations and Teaching Points



  • Suggest the use of additional lubrication during sexual intercourse.


  • Advise sexually active older men that spermatogenesis may continue into advanced age.


  • Address risks and benefits of time-limited hormone replacement therapy for symptomatic relief related to menopause.


Renal and Body Composition



Assessment Findings



  • Usually asymptomatic.


  • Increased incidence of anemia.


Nursing Considerations and Teaching Points



  • Be aware that although serum creatinine may be within normal range, creatinine clearance may be decreased. To obtain an accurate creatinine clearance in an older adult, the following formula may be used: (140 — age)(weight [kg])/(72) (serum creatinine [mg/dL]).


  • Drugs that are cleared through the kidneys may be given in decreased dosage. Adverse effects and toxicity must be closely monitored.


  • Consider the advantages and disadvantages of drug management for anemia associated with renal disease.


Skin



Assessment Finding



  • Dry, irritated skin.


Nursing Considerations and Teaching Points



  • Excessive use of soap, which can be drying to the skin, should be avoided.


  • Careful skin evaluation and lubrication are necessary to prevent fissures and breakdown.


  • Heat regulation needs to be controlled by proper clothing and avoidance of extreme temperatures.


  • Avoid direct application of extreme hot or cold to skin because damage may occur without feeling it.


  • Encourage use of sunscreen during all outdoor activities.


Community and Home Care Considerations



  • Xerosis (dry skin) is a common problem for older adults. Treatment should include:



    • Drinking 2,000 mL of liquid daily.


    • Total body immersion in warm water (90° to 105° F [32.2° to 40.6° C]) for 10 minutes.


    • Use of nonperfumed soap without hexachlorophene.


    • Application of emollient, particularly those with alphahydroxy acids, after bathing and at bedtime.


Hematopoietic



Assessment Finding

Asymptomatic


Nursing Considerations and Teaching Points



  • Anemia and granulocytopenia are not normal consequences of aging and should be investigated.


  • Teach patients that there is no need to take oral iron unless there is an actual documented decrease in iron levels.


  • Encourage oral B12 and folate replacement to manage associated anemias.



Altered Presentation of Disease



Assessment Findings



  • The classic indicators of disease are usually absent or disorders present atypically (see Table 9-1).


  • Older people are less likely to report new symptoms but, rather, attribute them to aging or existing conditions. Many older adults minimize symptoms because of fears of hospitalization or health care costs.








Table 9-1 Atypical Presentation of Disorders in the Older Adult













































DISORDER


ATYPICAL PRESENTATION


Acute intestinal infection


• Abdominal pain may be absent.


•May present with acute confusional state, leukocytosis, and acidosis.


Appendicitis


•Pain may be diffuse, not localized in right lower quadrant.


Biliary disease


•Confusion, declining function, and other nonspecific symptoms.


•Abnormal liver function tests may be only sign.


Heart failure


•Initially, may have change in mental status and fatigue.


Hyperthyroidism


•Apathy, palpitations, weight loss, weakness.


Hypothyroidism


•Presents with weight loss.


Myocardial infarction


•Chest pain may be absent.


•May present with syncope, dyspnea, vomiting, or confusion.


Perforated ulcer


•Rigidity may be absent until late.


Pneumonia


•May present with confusion.


•Fever and cough may be absent.


Pulmonary embolism


•May present with change in mental status.


•May not have fever, leukocytosis, or tachycardia.


Septicemia


•May be afebrile.


Systemic lupus erythematosus


•Pneumonitis, subcutaneous nodules, and discoid lesions are more common.


•Malar rash, Raynaud’s phenomenon, and nephritis are less common.


Urinary tract infection


•Confusion.



Nursing Considerations and Teaching Points



  • Have a high index of suspicion for underlying illness if the older adult presents with an acute change in cognition, behavior, or function.


Functional Assessment

Functional assessment is the measurement of a patient’s ability to complete functional tasks and fulfill social roles, specifically addressing a patient’s ability to complete tasks ranging from simple self-care to higher-level activities. It provides the nurse with objective data to help determine the older adult’s needs and plan interventions.


Purpose



  • Functional assessment is essential in the care of the older adult because it:



    • Offers a systematic approach to assessing older adults for deficits that commonly go undetected.


    • Helps the nurse to identify problems and utilize appropriate resources.


    • Provides a way to assess progress and decline over time.


    • Helps the nurse evaluate the safety of the patient’s ability to live alone.


  • Functional status includes the evaluation of sensory changes, ability to complete ADLs and instrumental ADLs, gait and balance problems, and elimination.



Instruments to Measure Functional Ability



  • Functional status may be assessed by several methods: self-report, direct observation, or family report. Direct observation is the method of choice, when possible.


  • The instrument chosen should be based on the specific goal or purpose for the evaluation. For example, if the focus is on basic self-care and mobility, the Barthel index should be used. See references, page 195 (Mahoney & Barthel).


  • The Katz Index for Activities of Daily Living and Instrumental Activities of Daily Living is another rating scale for measuring functional ability. Use this scale to determine level of independence of the older adult and repeat periodically to compare level of functioning over time. See references, page 195.


  • Performance measures, such as the Tinetti Gait and Balance measure or the Chair Rise test, can be used to evaluate higher-level functioning.


Psychosocial Assessment


Altered Mental Status



  • Assessment of mental status to detect altered cognition involves examination of memory, perception, communication, orientation, calculation, comprehension, problem solving, thought processes, language, visual—spatial abilities, abstraction, attention, aphasia, and apraxia.


  • Assessment can be facilitated by use of cognitive screening tools. A commonly utilized instrument is the Mini-Mental State Examination (MMSE), a 30-point cognitive screening instrument that assesses orientation to time and place, registration and recall, calculation, language skills, and visual—spatial abilities.


  • The total possible score is 30. A score of 24—30 suggests intact cognitive function; 20—23, mild cognitive impairment; 16—19, moderate cognitive impairment; 15 or less, severe cognitive impairment. The MMSE can help to follow the patient’s cognition over time and assess for acute and/or chronic changes.


  • Although success on scales such as this has been associated with language abilities, education, and socioeconomic status, this scale continues to be used as an appropriate screening tool for abnormal cognitive function.


  • Another cognitive screening instrument is the Mini-Cog examination, which is composed of a three-item recall and the Clock Drawing Test (CDT). The Mini-Cog can be administered under 3 minutes, does not appear to be affected by the patient’s education or language abilities, and has been successfully used to screen for dementia across a variety of clinical settings. The Mini-Cog can be administered as follows:



    • Tell the patient to listen carefully and remember and repeat three unrelated words.


    • Tell the patient to draw the face of a clock including numbers and hands to read a specific time. The CDT is considered normal if all numbers are present in the correct sequence and position and the hands display the requested time.


    • Ask the patient to repeat the three previously stated words.


    • Unsuccessful recall of all three items suggests dementia. Successful recall of all three items suggests intact cognition. An abnormal CDT with one to two errors on recall suggests dementia. A normal CDT with one to two errors on recall suggests no dementia.


  • Assessment of altered mental status or behavior may elicit criteria that lead to a diagnosis of dementia. It is essential to differentiate dementia from delirium (which is treatable and reversible).



    • Delirium is abrupt in onset and is commonly due to an underlying medical condition, such as infection, electrolyte imbalance, medication intolerance or toxicity, and cardiac decompensation. Disorientation occurs early, and the behavior is variable hour to hour. There is a clouded, altered, or changing level of consciousness, short attention span, and disturbed sleep—wake cycle. Hallucinations are common. The condition is reversible with treatment of the underlying cause.


    • Dementia has a gradual onset. Behavior is usually stable, and disorientation occurs late. Consciousness is not clouded, attention span is generally not reduced, and daynight reversal of sleep—wake cycles can occur rather than hour-to-hour variation. Delusions (fixed false beliefs) are more common than hallucinations.


Social Activities and Support



  • Social support for older adults is generally instrumental, informational, or emotional. The social environment is important with regard to recovery of acute medical problems and management of chronic illness.


  • Elicit information by asking such questions as:



    • How often do you socialize with others?


    • With whom do you socialize?


    • What type of activities do you enjoy?


    • Do you enjoy socializing?


    • Who can you call for help?


    • Do you know of any church or community groups you can call for help?


Emotional and Affective Status



Nursing and Patient Care Considerations



  • Treatment of depression should be given to older adults and includes drugs, psychotherapy, and, in some cases, electroconvulsive therapy.


  • Complement other therapeutic measures by providing opportunities to increase the patient’s self-esteem.



    • Encourage participation in meaningful activities.


    • Promote the patient’s positive self-image.


    • Help the patient develop a sense of mastery.


    • Encourage reminiscence of meaningful past events.


  • Help patient identify and use social supports.


  • For behavioral problems (agitation, combative behavior, or irritability) consider options such as aromatherapy, music therapy, pet therapy, relaxation techniques, massage, or physical activity.


Motivation in Older Adults



Nursing and Patient Care Considerations



  • Strategies to improve motivation include:



    • Establish whose motives are being discussed—patient’s, family’s, or health care provider’s; involve patient in setting the goals.


    • Explore with patient any indication of fear or other unpleasant sensation associated with the activity, such as pain or fatigue, and implement interventions to decrease these unpleasant sensations.


    • Evaluate the spokes of the wheel to consider the many factors that influence motivation and implement interventions as appropriate.


    • Encourage patient to verbally express emotional factors associated with the activity.


    • Examine the setting for the desired behavior to occur. Is the environment too stressful, too dark, or too noisy?


    • Attempt to use role models. Older adult role models can change ageist attitudes and stimulate patients to perform the desired behavior.


    • Set small goals to be met either daily or each shift. This provides frequent rewards.


    • Do not be afraid to use yourself. Research has indicated that being nice, demonstrating caring, using humor, verbal encouragement, and support can all help motivate the older adult.


  • Educate the older adult about the benefits of the activity, whether these are physical or psychological.


HEALTH MAINTENANCE



Primary Prevention

The goal of health promotion and disease prevention is to add more quality years to life. There are three levels of health promotion and disease prevention.

Primary prevention is the prevention of disease before it occurs. Primary prevention can be broken down into counseling, immunizations, and chemoprophylaxis.


Counseling



  • Encourage smoking cessation.



    • Approximately 10% of people in the United States age 65 and older are smokers.


    • Tobacco use has been linked to heart disease; peripheral vascular disease; cerebrovascular disease; chronic obstructive pulmonary disease; cancer such as lung, bladder, and esophageal malignancies; and numerous other health problems that decrease quality of life or cause premature death.


    • Although much damage has been done to the lungs and blood vessels by many years of smoking, older adults can still benefit from smoking cessation by increasing quality of life.


    • The U.S. Preventive Service Task Force recommends the “5-A” behavioral counseling framework as a useful strategy for engaging patients in smoking cessation discussions: (1) Ask about tobacco use; (2) Advise to quit through clear personalized messages; (3) Assess willingness to quit; (4) Assist to quit; and (5) Arrange follow-up and support.


  • Encourage physical activity.



    • It has been stated that 75% of older Americans are inactive.


    • It has been recommended that older adults participate in regular activity, especially aerobic activities that promote cardiovascular fitness, such as walking, cycling, or swimming.


    • Refer to a physical, occupational, or rehabilitation therapist. An individualized exercise prescription should be developed and cleared with the health care provider.


  • Identify alcohol abuse in older adults.



    • The consequences of alcoholism include liver disease, gastrointestinal (GI) bleeding, and motor vehicle accidents.


    • Question older adults about drug or alcohol abuse. Although street drug use is rare, prescription drug abuse may be occurring or alcohol may be used for pain.


    • Recognize the signs and symptoms of alcohol abuse in older adults (see Box 9-1).


    • Refer for counseling.


  • Evaluate and counsel on dental health.



    • Dental problems in older adults include missing teeth, illfitting dentures, periodontal disease, and tooth decay.


    • Dental problems commonly lead to poor eating habits, apathy, and fatigue.


    • Regular dental care should be encouraged to improve nutrition and the quality of life.


Immunizations






  • Pneumococcal pneumonia and influenza are significant causes of mortality and morbidity in older adults.



    • It is recommended that a single dose of the pneumococcal vaccine be given to all people age 65 or over.


    • A second dose is recommended for individuals aged 19 to 64 who have functional or structural asplenia or immunocompromising conditions 5 years after the first.


    • Influenza may cause significant complications in older adults. Annual influenza vaccination is recommended for all people over age 6 months. Several antiviral agents are effective against influenza. These agents can be effective in ameliorating symptoms if given within 48 hours of onset of illness.


  • Tetanus-diphtheria (Td) immunization is an important but frequently forgotten component of health maintenance, especially in older adults.



    • The mortality rate of tetanus exceeds 50% in those over age 65.


    • Combined tetanus-diphtheria boosters should be given every 10 years; no age for discontinuation has been stated.


    • Due to an increase in pertussis cases, a single dose of acellular pertussis is also recommended as a component (Tdap) for adults aged 65 years and older who anticipate having close contact with an infant less than 12 months of age and who previously have not received Tdap. Tdap can be administered regardless of interval since the last tetanus booster.


    • For those with no history of immunization or unknown immunization status, a primary series should be initiated, consisting of two doses of tetanus-diphtheria vaccine at least 4 weeks apart, followed by a third dose 6 to 12 months later.


  • A single dose of the herpes zoster vaccine is recommended for older adults to prevent the dermatologic reoccurrence of varicella and the possible painful sequela known as postherpetic neuralgia.



    • Age is the most important factor in the development of herpes zoster, with a large increase beginning between age 50 and 60, and about 50% of people experience herpes zoster by age 85.


Chemoprophylaxis



  • The risk and benefits of oral anticoagulation therapy should be considered for older adults at risk of cardiovascular disease, particularly stroke. The United States Preventive Services Task Force (USPSTF) strongly recommends that clinicians discuss aspirin therapy with patients at risk for coronary heart disease.



    • Contraindicated if patient is at risk for GI bleeding.


    • Should be discussed with older adults with regard to prevention of deep vein thrombosis, nonvalvular atrial fibrillation, cardiomyopathy, valvular heart disease, mechanical prosthetic heart valves, and acute myocardial infarction.


  • Calcium, vitamin D, and other agents, such as selective estrogen receptor modulators or bisphosphonates, may be considered for those at risk for osteoporosis.


Secondary Prevention

Secondary prevention is the detection of disease in an early stage for best treatment outcomes, such as cancers, cardiovascular disease, osteoporosis, and tuberculosis.


Screening Recommendations


Age alone is not a criterion as to when to stop screening. Rather, the patient and health care provider should discuss values, expectations, functional status, and quality of life. A guide to shared decision making for cancer screening is available at the USPSTF website at www. uspreventiveservicestaskforce.org/3rduspstf/shared/sharedba.htm. The USPSTF has made the following recommendations for cancer screenings for older adults:



  • The precise age at which to discontinue screening mammography is uncertain. No clinical trials have been conducted on women over age 74. Furthermore, although older women face a higher probability of developing breast cancer, they also have a greater chance of dying from other causes.


  • Regarding cervical cancer, it is appropriate for older women to discontinue cervical cancer screening after age 65 only if they have had adequate recent screening with normal results and are not at high risk for cervical cancer.


  • The age to discontinue colorectal cancer screening has not been determined; however, the USPSTF recommends against routine colorectal cancer screening in adults ages 75—85, unless there are conditions that support screening for these individuals.


  • The USPSTF states that there is insufficient evidence to recommend for or against screening for prostate cancer. Older men and men with other significant medical conditions who have a life expectancy of fewer than 10 years are unlikely to benefit from the prostate-specific antigen test and digital rectal examination.


Tertiary Prevention

Tertiary prevention addresses the treatment of established disease to avoid complications and death. The major areas of focus for the older adult are preventing the complications of immobility and rehabilitation


Preventing Complications of Immobility


Positioning



  • The goal of frequent position changes is to prevent contractures, stimulate circulation and prevent pressure sores, prevent thrombophlebitis and pulmonary embolism, promote lung expansion and prevent pneumonia, and decrease edema of the extremities. Changing position from lying to sitting several times per day can help prevent changes in the cardiovascular system, which is known as deconditioning.


  • The recommendation is to change body position at least every 2 hours and, preferably, more frequently in patients who have no spontaneous movement.


Jul 20, 2016 | Posted by in NURSING | Comments Off on Care of the Older or Disabled Adult

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