Safety and Security Issues of Aging

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Safety and Security Issues of Aging
Gerontological Community Based Nursing
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Environment

• Older adults want to stay in their own homes
  independently as long as possible
• Mobility, transportation and safety factors often
  affect the living patterns of older adults

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Why do older adults change living conditions?

• Death of a spouse
• Divorce
• Change in economic circumstances
• Loss of health
• ? d cognitive or functional status
• Availability of family
• Personal preference
• 6.5 million older adults need assistance with
  daily living

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Staying at home

• Most common chronic conditions affecting older
  adults
• Arthritis
• HTN
• Heart disease
• Hearing impairment
• Diabetes
• To maintain independence, we must identify needs
  and appropriate interventions

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Home

• Approximately 70 of older adults live in family
  setting
• 4-6 live in a nursing home
• 78 of older householders owned their home
• 22 are renters

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Assisted Living

• Fastest growing type of senior housing in the US
• Goal is to maintain or enhance the frail elders
  capabilities to remain as independent as possible

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Homelessness

• Housing needs of homeless elders are often
  ignored
• Older people who are homeless as a result of
  uncontrollable circumstance and dont receive a
  range of services and support

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Safety and Security Issues

• Crime
• Safety
• Driving
• Involved in more motor vehicle accidents than
  younger people
• Sensory and cognitive changes have adverse
  effects on driving ability
• Fall Risk

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Falls

• 30 of community based older adults fall each
  year
• Most falls occur in the home
• Key areas to assess
• Adequate lighting and access to switches
• Safe flooringlook for cords
• Safe stairways
• Adequate toilet height
• Kitchen-access to items
• Smoke alarms
• Clutter
• Medications--?labeled
• Safety of neighborhood
• Distance to bathroom
• Ease of getting in/out of chair

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Transportation

• Transportation assessed as part of IADL
• 0independent, drives a car
• 1arranges own transport, depends on others
  except for walking
• 3assists in own transport but needs special
  accommodation e.g. wheelchair
• 5completely homebound even for medical care

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Alternatives to Driving

• Reduced-fare taxis
• Volunteer drivers
• Public transportation
• Chartered buses
• Dial-a-ride programs

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Musculoskeletal Problems

• Mobility Problems, Falls, and Fractures
• Functional elements needed for mobility
• Cognition and motivation
• Skeletal system
• Muscular system
• Neurological system

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Mobility changes with aging

• Loss of bone mass
• After age 40-50 there is incremental process of
  bone absorption without new bone formation gt
  gradual bone loss
• Loss of muscle strength
• Decrease of reaction time
• Decreased speed of movement

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Common health problems affecting mobility in
older adults

• Osteoporosis
• Osteomalacia
• Arthritis
• Polymyalgia rheumatica
• Fibromyalgia
• Foot disorders

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Falls

• 2nd leading cause of all accidental deaths
• Important health issue in those gt75
  y.oespecially women
• Causes
• Physical frailty, visual impairment
• Environmental hazards
• Most occur during the day
• Previous falls, predictor of future falls

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Nursing Diagnoses

• Injury, risk for related to falls
• Mobility, impaired physical
• Goals prevent injury, promote optimum mobility,
  prevent deformity
• Interventions assistive devices, maintain
  adequate nutrition fluid intake maintain
  normal elimination

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Fractures

• Hip fractures have high morbidity and mortality
• 15-20 of patients die as a result of
  complications
• Immobility
• Pneumonia
• Sepsis/UTI
• Pressure ulcers

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Pain

• Definition
• Unpleasant sensory and emotional experience
  associated with actual or potential tissue damage
• Whatever the patient says it is.
• Incidence
• 25-50 of community-based elders have pain
• Up to 85 for long-term care residents report
  pain
• 73 of hospitalized medical patients say pain was
  excruciating

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Pain Assessment

• Pain too
• Pain descriptions
• Pain observation

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Pharmacological Management of Pain

• Medications to be avoided in older adults
• Demerol
• Causes confusion
• Talwin
• Confusion, disorientation
• Methadone
• Long half-life accumulates over time
• Darvon
• confusion

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Rule of Thumb

• Start Low
• Go Slow

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Nurses and Pain

• Nurses fear addicting patients, fear giving
  narcotics, give less than prescribed dose or
  minimal doses
• Result Patients suffer!!
• Nurses underestimate patients pain
• Result Patients suffer!!
• Nurses make incorrect assumptions about pts pain
  because pts do not behave according to nurses
  expectations
• Result Patients suffer!!
• Nurses and patients believe that pain is a
  natural part of aging
• Result Patients suffer!!

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Nonpharmacologic Management of Pain

• Touch
• Natural method of comforting, promotes
  relaxation, said to promote healing
• Relaxation
• Meditation
• Imagery
• Massage
• Heat/cold
• Accupuncture/Accupressure
• TENStranscutaneous electrical nerve stimulation
• Distraction

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Medications

• Nursing home patients receive an average of 6
  drugs/day
• 45 take 7 or more/day
• 20 take more than 10/day
• 60 of all visits to a physician for pts agegt50
  include renewal, continuation, or prescription of
  at least one medication
• Prescription use increases with age
• One in 13 prescriptions received from office
  based physicians involves a potentially
  inappropriate medication

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Polypharmacy

• The excessive use or unnecessary medications with
  associated increased risk of drug interactions
  and other adverse effects
• Causes
• Inadequate diagnosis
• Inappropriate prescribing
• Multiple prescribers w/out adequate communicating
• Failure to d/c medications that are no longer
  necessary
• Failure to agree on therapeutic endpoint
• Inadequate or ineffective family/patient education

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What to do
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• Aspirin can increase the effect of
  anticoagulants, penicillins
• Antacids can decrease the effect of aspirin
• Antidepressants can increase the effect of
  narcotics
• Meperidine can decrease the effect of glaucoma
  medication

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Adverse Drug Reactions

• Any undesirable or unintended effect occurring
  with medication dosages
• 2-3 times more likely to occur in older than in
  younger adults
• Drug-drug interactions
• Drug-nutrient interactions
• OTCs, vitamins, and foodstuffs
• Drug-disease interactions

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Noncompliance

• Non-adherence to medication prescription
• Risk factors
• Multiple medications
• Recent prescription changes
• Inability to name prescriptions
• Multiple practitioners
• Vision defecits
• Inability to perform a simple calculation
• Inability to judge an appropriate twice-daily
  dosing schedule

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Assessment

• Review all medications (prescriptions, OTC,
  herbal supplements, folk remedies, etc.) at least
  Q 6 months
• What is the purpose of the drug?
• Has the aphorism start low, go slow been
  followed?
• Are there any patient allergies that have not
  been reported?
• Are there drug-drug interactions that need to be
  checked?
• Has the most effective route of administration
  been selected?

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Assessment contd

• Assess patient and/or family knowledge of
  medications and the ability to
• Follow instructions
• Monitor for adverse effects
• Make decisions about contacting the physician
• Assess the environment for proper storage,
  delivery systems, and memory prosthetics

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Nursing Diagnoses

• Noncompliance with medication regimen related to
  visual deficit
• Self-care deficit, medication related to
  diminished cognitive functioning
• Injury, risk for related to an adverse drug
  reaction (e.g. hypotension, dehydration,
  dizziness)

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Nursing Interventions

• Medication administration
• Helping pts locate or create memory prosthetics,
  such as pill dispensers, calendars, check-off
  systems
• Medication management
• Understanding the therapeutic goal and the
  pathophysiology of the disease to be treated
• Using this goal for monitoring the efficacy of
  the drug

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Nursing Interventions contd

• Medication prescribing
• Nurse should recognize principles of
  pharmacoeconomics that may affect the drug
  selection behaviors of the primary care provider
• Unit cost of the drug
• Cost of administering the drug (special skills or
  assistance needed)
• Costs associated with managing side effects
• Costs associated with monitoring the patient (lab
  work, home/physician visits)

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Nursing Interventions contd

• Patient teaching
• Drug names (generic and brand)
• Drug indications
• Dosage
• When and how to administer the medication
• Contraindications
• Adverse effects and drug interactions
• Storage
• Demonstration and return demonstration
  opportunities
• Anticipatory guidance about OTCs
• Creating a portable medication record to share
  with all providers