Transcript Alterations in Neurological Systems of Older Adults

Health Alterations
in
Older Adults
Janet Duffey, RN, MS,
APRN, BC
Think About This….
 A group of Florida senior citizens were talking
about their ailments.
 "My arms are so weak I can hardly hold this
cup of coffee."
 "Yes, I know. My cataracts are so bad I can't
even see my coffee."
 "I can't turn my head because of the arthritis
in my neck."
 "My blood pressure pills make my dizzy."
"I guess that's the price we pay for getting
old."
 "Well, it's not all bad. We should be thankful
that we can still
drive."
General Changes
 Non regeneration
 Loss of neurons in cerebral cortex
 Decreased oxygen, blood flow
 Impaired thermoregulation
 Susceptibility in choline
 Dopamine
 Alteration in functional mobility
Neurological Diseases
 Parkinson’s: pill rolling, tremors,
forward gait, mask like
expression, depression
 Stroke (CVA): location, right brain,
left brain, motor tracts
 Hemorrhagic, occlusive,
thrombotic
 TIA’s – mini-thrombotic episodes
resolving in 24 hours or less
CVA’s
 Effects of CVA’s
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language
Speech
Sensation
perception
behavioral style
memory and
holistic assessment
 Expressive aphasia (Broca’s) frontal lobe
damage
 Receptive aphasia (Wernike’s) left hemi
in temporal lobes
Impact of CVA
Overlooking Confusion
 Poorly understood event
 Multiple causes
 Misdiagnosis as “untreatable”
 Range of causes from age related
memory loss to pathological change in
brain
 Physical dysregulation: sleep,
temperature, electrolytes, sensory
overload
Nursing Interventions for Confusion
 Baseline mental status exams
 Detect and report: insomnia, distractibility,
hypersensitivity, c/o poor recall, nightmares
 Structure environment for moderate mental and
physical stimulation
 Limit duration of activity
 Evaluate new / added meds carefully
Confusion
Causes of Acute Confusion
 Metabolic
 Drug toxicity or side effects
 Drug withdrawal
 Electrolyte imbalance
 Endocrine dysfunction
 Hypoxia
 Infection and sepsis
Alzheimer’s Disease
 Genetic predisposition
 Presence of amyloid plaques &
neurofibilary tangles (key finding on scans
& autopsy)
 Reduced presence of choline required for
cognition (major biochemical change)
Dementia: Early Stage
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Mood change
Poor judgment
Getting lost
Difficulty with numbers
& money
 Withdrawal or
depression
Middle Stage AD
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Gross memory impairment
Aphasia: speech disturbance
Loss of impulse control
Anxiety
Wandering
Confabulation
Progressively lowered stress threshold
Impaired self-care due to judgment
Late Stage AD
 Dysphagia with risk for aspiration
 Impaired speech, little or no
communication
 Immobile, non-ambulatory
 Totally dependent in all activities of daily
living
 Morbidity by aspiration pneumonia or
sepsis common
Rx: Cholinesterase Inhibitors
 Cholenergic Drugs: Cognex,
Aricept Rivastigmine,
improving concentration of
acetylholine
 Memantine: newly approved
 Side effects: nausea, bradycardia,
elevated liver function studies
 Used in early to middle stages
Behaviors in Dementia
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Perseverance
Tactile wandering
Recreational
Purposeful
“Sundowning”
Gross agitation
Hallucinations
Delusions
Interventions for Behaviors
 Determine underlying need
 Check for pain, hunger, toileting issues
 Decrease stress if possible
 Encourage rest periods
 Engage in activities related to premorbid
personality and role
 PRN medications as a last resort, sparingly
Non-AD Dementias
 Pick’s Disease
 Lewy Body Dementia
 Vascular Dementia
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Risk factors
MRI. CT findings
Prevention
Treatment of
symptoms similar to
AD
Renal / Urinary System
 Renal function
 Hydration
 Obstructive conditions
 Incontinence
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Stress
Urge
Overflow
Functional
Interventions
 Moderate fluid intake
 Regular toileting
 Treatment of infection
 Estrogen therapy
 Timing of diuretics
 Medication assessment for contributors
 Bladder retraining
Changes in Skin
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Easily torn & blistered
Decreased sensation leads to risk for injury
Impaired thermoregulation
Dryness
Photo aging, cancers, basal cell
epitheliomas, squamous cell carcinomas,
multiple melanoma
 Increased risk for fungal infections
 Implications for nursing care:
- Teaching to prevent sun exposure
- Avoid excessive bathing
- Role of nutrition and hydration
- Pressure relief measures
- Assessment: Braden Pressure Scale
Pressure Ulcers in Elderly
 Prevalence varies by setting
 Risk factors for elderly
– Acute immobility due to illness
– Paralysis
– Hip fracture
– ICU/Critical care units
– Nutritional state
Braden’s Conception of Risk
 Decreased mobility
 Decreased activity
 Decreased sensory
perception
 Increased: moisture,
friction, shear
 Poor nutritional intake
 Advanced age
 Impaired circulation
Alterations in GI Function
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Decreased GI acidity
Constipation
Changes in appetite
Role of dental problems
Diverticulosis
Colon cancer
Self management of
colostomy
Interventions for Constipation
 Constipation vs.
obstruction
 Definition of “regularity”
 Establish fluid intake of
2000cc daily
 High fiber diet: bran,
fruits, vegetables, whole
grains
 Limit use of enemas and
stimulants which cause
more dehydration
Alterations in MS Status
 Osteoarthritis
 Rheumatoid arthritis
 Osteoporosis
 Falls
 Fractures: vertebral, pelvis, hip, shoulder,
wrist
 Normal: decreased muscle mass, less
elastic, shrinking height
Interventions for MS
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Diet, calcium, vitamin D
HRT: estrogen
Exercise
Safety measures
– Hazards of immobility
– Identification of appropriate activities
– Fall prevention & home safety
Risk Factors for Falls
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Sensory deficits
Cardiac contributors
Neurological
Urological
Pharmacological
Alcohol
Environment
Fall history
Interventions for Falls
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Identify fear of falling
Increase activity
Strengthening exercises
Orthostatic monitoring
Use of assistive devices
Safe, non-skid footwear
Correct sensory deficits
 Plan how to get help
after a fall
 Remove known
hazards: rugs, clutter
 Identify activities
requiring supervision
/ assistance
 Teach caregivers
proper lifting or
transfer techniques