NCM114COP MIDTERM

CHANGES IN THE OLDER ADULT

INTEGUMENT KEY POINTS OF THE STUDY:
o As the person ages, many significant changes occur; Aromatherapy – the use of essential oils
some are visible and some are not Essential oils – lavender, chamomile, etc.
o The integument includes body membranes, skin, Results: Aromatherapy increases skin moisture levels in
hair, fingernails, and sweat and oil glands all zones since olive oil is to the arms and the back only
o The skin has multiple layers that protect the body,
help regulate body temperature, and help excrete How can we prevent skin injury and maintain healthy
wastes via sweat skin to the older adult?
o The skin is a barrier o Prevent dryness by using aromatherapy or use
o Forms the external body covering; protects deeper emollient lotion by rubbing after bath when the skin is
tissue from injury; synthesizes vitamin D; location of still moist so it can be absorbed
sensory receptors (pain, pressure, etc.) and sweat o Ensure optimal nutrition for the older adult (taking
and oil glands vitamins or supplements)
o Maintain adequate hydration for older adults
NORMAL PHYSICAL CHANGES ASSOCIATED WITH o Reduce stress
AGING (INTEGUMENTARY) o Limit exposure to sunlight
1. Increased skin dryness o Protect skin from sun damage by using sunscreen
• due to decreased sebaceous gland activity and with SPF of 15 or higher, wear protective clothing
tissue fluid such as light long sleeves, wear sunglasses, hat,
2. Increased skin pallor visors, or wide brimmed hats.
• due to decreased vascularity o Observe skin changes such as changes in size of
3. Increased skin fragility color of the mole or if there are new lesions. If able to
• skin gets easily bruised due to reduced thickness take note of skin changes, advise the client to seek
and vascularity of the dermis medical evaluation.
4. Progressive sagging (can be seen in eyelids, arms, o Prevent skin injury by instructing them to avoid rough
abdomen, breast) and wrinkling of the skin texture in clothing such as denim, highly starched
5. Decreased perspiration linens, and zippers.
6. Aging skin looks thinner o Use soft wash cloth, and avoid using strong detergent
7. They get easily cold in washing their clothes.
• due to loss of subcutaneous fats o Avoid using skin products that heavily contain
• schedule patients bathing time and put warm alcohol or perfume because it can dry the skin.
water to use, but take note that skin is also drying o Assess the frequency of bathing or showering.
8. Brown spots (age spots or lentigo senilis)
• can be seen in exposed body parts o due to NEURO/MUSCULAR/SKELETAL
clustering of melanocytes or the pigment 1. Slowed reaction time
producing cells • due to diminished speed of nerve fibers and
9. Skin elasticity or turgor decreased muscle tone
10. Veins are visible • movement is regulated by signals; the brain will tell
11. Thinning and graying of scalp, pubic, and axillary the nerve fibers to let the muscles contract.
hair • in connection to the wear and tear, there is slowed
12. Slower nail growth and increased thickening with reaction time.
ridges • muscle weakness
13. Hair loss or thinning of the hair 2. Loss of height (stature)
• due to atrophy of intervertebral disks
THE EFFECT OF AROMATHERAPY ON ELDERLY • Kyphosis – humpback of the upper spine
PERSONS WITH DRY SKIN: A RANDOMIZED 3. Loss of bone mass
CONTROLLED TRIAL • due to bone reabsorption outpaces bone
reformation
Dry skin, which is one of the most frequent • before the bone can be renewed, it is broken
dermatological problems seen in the elderly population, faster, making it porous and fragile
is an important problem that increases with aging. • fracture can occur
4. Decreased speed and power of skeletal muscle
When examining between measurements differences of contractions
the groups in the study, skin moisture levels of the elderly • due to decrease in muscle fibers
individuals in the aromatherapy group increased in all • with age, skeletal muscles atrophy and decrease
zones, arm, leg, back, and chest, at measurements of the in mass, and the speed and force of their
second and fourth weeks compared with the first contraction reduce
measurements. This improvement was determined to be • this phenomenon, known as senile sarcopenia,
higher after the second week. is accompanied by a decrease in physical
strength.
 NCM114COP MIDTERM
• Sarcopenia can impair the ability to perform • Fatty deposits; reason why older adults have
everyday tasks such as rising from a chair, doing impaired peripheral vision
housework or washing oneself 4. Progressive loss of hearing (Presbycusis)
• one cause of sarcopenia is nutrition under • due to thickened eardrum or impacted
women. encourage exercise in the form of walking cerumen
to strengthen weakened muscles. • older adults need to have their ears checked
5. Joint stiffness regularly; assess their ears for impacted
• due to drying and loss of elasticity in joint cartilage cerumen
6. Impaired balance • sometimes, older person does not participate
• due to deceased muscle strength, reaction time in family conversations anymore
and coordination 5. Decreased sense of taste, especially the sweet
7. Greater difficulty in complex learning and sensations at the tip of the tongue
abstraction • tongue atrophy
• due to fewer cells in cerebral cortex • older adults might experience loss of appetite
(consciousness, thought, emotion, reasoning, • they can’t sense if the food is spoiled
language, and memory) • schedule small frequent meals; serve in
• speed in processing information is difficult but it portions
does not mean they will not learn new ideas • do not rely on hunger because this will also
decline with age
As a person gets older, changes occur in all parts of the 6. Decreased sense of smell
body, including the brain: affect mental function • due to atrophy of the olfactory bulb at the base
of the brain
1) Certain parts of the brain shrink, especially those • when the client is cooking, he or she cannot
important to learning and other complex mental sense if there is already burnt food
activities. • sensitive to strong scents
2) In certain brain regions, communication between • older adults can have the tendency to smell
neurons (nerve cells) may not be as effective. hazardous wastes or chemicals
3) Blood flow in the brain may decrease. • label chemicals and place away within the
reach of the older person
KEY POINTS: 7. Increased threshold for sensations of pain,
o The skeleton acts as a calcium reservoir. touch and temperature
o Insufficient levels of calcium or vitamin D (essential • thinner skin, nerve conduction changes
for calcium absorption) can lead to a reduction in • a nerve is a bundle of fibers that receives and
bone density and increase predisposition to sends messages between the body and the
osteoporosis and fractures. brain.
o In older people, the gut absorbs less calcium and
vitamin D levels tend to decrease, which reduces PULMONARY
the amount of calcium available for the bones. 1. Decreased ability to expel foreign or
o The age-related degeneration of the accumulated matter
musculoskeletal system makes older people prone 2. Difficult, short, heavy, rapid breathing (dyspnea)
to frailty, falls and fractures following intense exercise
o Sarcopenia is produced by the atrophy and
shrinkage of skeletal muscles, coupled with a CARDIOVASCULAR
reduction in the speed and force of their contraction 1. Working capacity of the heart diminishes with
(that’s why reflexes are slow). age
o Osteoporosis and osteoarthritis commonly occur in • evident when increased demands are made in
old age as a result of bone changes the heart such as periods of exercise of
o To have a healthy musculoskeletal system, it is emotional stress
essential that older people keep as physically active • heart rate at normal rest may decrease with age
as possible • however, the heart rate of the older person is
slower to respond to stress and slower to return
SENSORY-PERCEPTUAL to normal after periods of physical activity
1. Loss of visual acuity • reduced arterial elasticity may result to
• degeneration leading to lens opacity diminished blood supply (such as in the legs and
(cataracts), thickening and inelasticity brain), resulting to pain on exertion in the calf
(presbyopia) muscles and dizziness
2. Increased sensitivity to glare and decreased 2. Delay in the circulatory adjustments (Orthostatic
ability to adjust to darkness Hypertension)
• changes in the ciliary muscles; rigid pupil • when a person is to stand up from a lying or
sphincter; decrease pupil size sitting position, the delay may result in an abrupt
• older adults can be prone to falling drop in systolic blood pressure
3. Partial or complete glossy white circle around • for blood pressure measurements, it is not
the periphery of the cornea (Arcus Senilis) unusual to have a slight increase in the systolic
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pressure while diastolic pressure remains the
same -> isolated systolic hypertension NURSING CONSIDERATIONS:
• for many years, isolated systolic hypertension 1) Check if medications administered are excreted
was considered to be normal but a recent study in the kidneys or liver
indicates that systolic pressure at or greater than • these drugs that are metabolized in the kidneys
140mmHg is problematic in older adults o may accumulate in the kidneys
should be treated with antihypertensive agents, • watch for signs of toxicity
diet and exercise -> new evidence
• obese older adults with hypertension will have NOTICEABLE CHANGES TO THE BLADDER
pathophysiological changes affecting the heart, 1. Complaints of urinary frequency and urgency
blood vessels and kidneys. Damage to the renal • the capacity of the bladder and ability to empty
system with comorbid cardiovascular disease diminish with age
increases the client’s risk of • many older adults need to void during the night
and may experience retention of residual urine
HEALTH EDUCATION: predisposing them to have bladder infections
1) Reduced fat diet – fatty deposits in the blood vessels 2. Urinary incontinence (not normal related to
2) Smoking cessation – constricts/narrows blood vessel aging)
3) Stress reduction • loss of bladder control
4) Limited salt intake • the nurse must promptly investigate urinary
5) Exercise incontinence particularly with the new onset
because this may give ill effects to older adults
SODIUM INTAKE AND HYPERTENSION including social isolation, falls, and skin
The close relationship between hypertension and dietary breakdown (especially if they are already
sodium intake is widely recognized and supported by wearing diapers and are not changed)
several studies. A reduction in dietary sodium not only
decreases the blood pressure and the incidence of HEALTH PROMOTING ACTIVITIES TO PROMOTE GOOD
hypertension, but is also associated with a reduction in URINARY FUNCTION:
morbidity and mortality from cardiovascular diseases. 1) Drink sufficient fluids 8-10 glasses of noncaffeinated
Prolonged modest reduction in salt intake induces a liquid
relevant fall in blood pressure in both hypertensive and 2) Drink even if not thirsty (thirst mechanism of older
normotensive individuals. adults is diminished)
3) Avoid foods that can irritate bladder (sugar, caffeine,
GASTROINTESTINAL alcohol, spicy, acidic, chocolate)
1. Periodontal disease can lead to tooth loss 4) Demonstrate or encourage older
• tooth enamel becomes harder and more brittle person to have pelvic floor exercises.
inflammatory disease the destroys teeth and
gum tissues GENITALS
• reduced production of saliva may lead to MEN
Xerostomia (dry mouth) 1. Degenerative changes in the gonad which is
• can make oral mucosa more susceptible to gradual in men
infection 2. Production of testosterone continues
2. Decreased esophageal motility can slow 3. Testes can produce sperm well although there is a
esophageal emptying process gradual decrease in the number of sperm
3. Stomach motility and emptying time decreases 4. Prostate enlargement (benign) in men (exact
mechanism is unclear)
HEALTH PROMOTION TEACHING: 5. Several age related changes in sexual response
1) Effective oral hygiene – especially for older people and performance
using dentures to prevent problems in the mouth; • it is important for both client and the nurse to know
brush and clean tongue and gums as well that sexual response and performance should be
2) Preventive dental care present in the older adult
3) Nutrition – look into the nutrition or food intake of the 6. More gradual decline of hormones in men
client; nutrition is a big part of health promotion compared to female
teaching 7. Decreased firmness of erection, increased
4) Regular bowel movement refractory period (men)

URINARY WOMEN
1. Excretory function of the kidney diminishes with 1. Cessation of menses in middle age and
age menopause
• usually not significantly below normal unless a 2. Shrinkage and atrophy in vulva, cervix, uterus,
disease process intervenes fallopian tubes, ovaries and changes in vaginal
2. Kidneys’ filtering abilities may also be impaired flora (diminished secretion of female hormones)
• waste products may be filtered and excreted 3. Increased time to sexual arousal decreased
more slowly vaginal lubrication (loss of estrogen effects)
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IMMUNOLOGIC MEMORY
o read on the reasons why older adults can still be • is a component of intellectual capacity
infected with COVID-19 though they are vaccinated
o consider changes in their immunologic responses SENSORY MEMORY
→ momentary perception of stimuli from the
PSYCHO-SOCIAL CARE OF OLDER ADULTS environment
I. COGNITIVE ABILITIES AND AGING
PERCEPTION SHORT-TERM MEMORY OR RECENT MEMORY
• Is the ability to interpret the environment, depends → memory held in the brain for immediate use or what
on the acuteness of the senses one has in mind at a given moment
• If sense are impaired -> the ability to perceive the → it also deals with activities or the recent past
environment and react appropriately is diminished minutes to a few hours
• Changes in the nervous system affect perceptual
capacity – brain losses mass, blood flow to the brain LONG-TERM MEMORY
decreases → repository of information for periods longer than 72
hours and usually weeks and years
COGNITIVE AGILITY → sometimes, this is a memory that is difficult to bring
• refers to the mental capability involving reasoning, back to the present especially if not used (e.g.
problem solving, planning, and idea comprehension birthdays, moments in childhood)
• Older adults can be confused or disoriented
• In older adults, cognitive abilities are more often a o In older adults, retrieval of information from long
difference in SPEED than in ability (slow learning term memory can be slower especially if the
process) information is not frequently used.
• Overall, the older adults maintain intelligence, o They tend to forget the recent past, but forgetfulness
problem solving, judgement, creativity and other can be improved using notes, lists, and placing
well practiced cognitive skills objects in consistent locations.
• As a nurse, come up with activities that can enhance
cognitive skills 7 WAYS TO KEEP YOUR MEMORY SHARP AT ANY AGE:
• Cognitive impairment that interferes with normal life 1. Keep learning
is not considered part of normal aging. • join a book group; play chess or bridge; write your
• A decline in intellectual abilities that interferes with life story; do crossword or jigsaw puzzles; take a
social or occupational functions should always be class; pursue music or art; design a new garden
regarded as abnormal (seek medical evaluation; layout
there might be developing dementia) 2. Use all your senses
• For example, try to guess the ingredients as you
GAMES TO PLAY WITH YOUR GRANDPARENTS smell and taste a new restaurant dish. Give
Games to improve cognitive function and memory: sculpting or ceramics a try, noticing the feel and
→ Jigsaw puzzles smell of the materials you’re using.
→ Card games 3. Believe in yourself
→ Chess • Myths about aging can contribute to a failing
Games to stay physically active: memory.
→ Balloon volleyball • People who believe that they are not in control of
→ Pickleball their memory function are less likely to work at
→ Tossing Games maintaining or improving their memory skills and
→ Dancing therefore, are more likely to experience cognitive
Traditional old-school games: decline.
→ Paper balls 4. Economize your brain use
→ Five Stones • Take advantage of calendars and planners,
→ Kuti Kuti maps, shopping lists, file folders, and address
→ Chapteh books to keep routine information accessible.
→ Zero Point • Designate a place at home for your glasses,
Games that encourage social interaction: purse, keys, and other items you use often.
• Remove clutter from your office or home to
→ Mahjong
minimize distractions, so you can focus on new
→ Bingo
information that you want to remember.
→ Board Games
5. Repeat what you want to know
• When you want to remember something you’ve
just heard, read, or thought about, repeat it out
loud or write it down. That way, you reinforce the
memory or connection.
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6. Space it out o A greater ability to cope with illness and disability

• Repetition is most potent as a learning tool because of a hopeful, positive attitude, and sense of
when it’s properly timed. It’s best not to repeat purpose
something many times in a short period, as if o People who use religious coping mechanisms are
you were cramming for an exam. less likely to develop depression and anxiety than
• Instead, re-study the essentials after those who do not; this inverse association is
increasingly longer periods of time—once an strongest among people with greater physical
hour, then every few hours, then every day. disability
7. Make a mnemonic
• This is a creative way to remember lists. HARMFUL EFFECTS OF RELIGION AND SPIRITUALITY
• Mnemonic devices can take the form of o Religion is not always beneficial to older adults.
acronyms Religious devotion may promote excessive guilt,
8. Learning inflexibility, and anxiety.
• older people need additional time learning, o The person recalls what happens during his or her
largely because of the problem younger years and may somehow cause guilt,
retrieving information inflexibility and anxiety
• older adults have more difficulty than younger o Certain religious groups discourage mental and
ones learning information they do not consider physical health care, including potentially
meaningful lifesaving therapies (e.g., blood transfusions,
• above are two important ideas to consider when treatment of life-threatening infections, insulin
planning interaction and health teachings to therapy), and may substitute religious rituals (e.g.,
older persons praying, chanting, lighting candles).
• assess the interests or things that are beneficial
or meaningful to your patient Before giving interventions to the patient, practice religion
• talk about topics that interest them and spirituality in the form of prayer. A nurse can pray
together with the patient.
II. MORAL REASONING
o the values and belief patterns that are important to
older adults may be different from those held by
younger people because they developed during a
time that was different from today

III. SPIRITUALITY AND AGING

Religion and spirituality are similar but not identical
concepts.
RELIGION
• is often viewed as more institutionally based, more
structured, and involving more traditional activities,
rituals and practices

SPIRITUALITY
• refers to the intangible and immaterial and thus may
be considered a more general term, not associated
with a particular group or organization
• it can refer to feelings, thoughts, experiences, and
behaviors related to the soul or to a search for the
sacred

Consider older adults’ beliefs and religion in the plan

of care

BENEFITS OF RELIGION AND SPIRITUALITY

o Can give a positive and hopeful attitude about life
and illness, which predicts improved health
outcomes and lower mortality rates
o A person has a support system in the organization or
church activity that he or she joins
o A sense of meaning and purpose in life, which
affects health behaviors and social and family
relationships