tabloski ch24 lecture

Gerontological NursingGerontological Nursing

CHAPTER

THIRD EDITION

Copyright © 2014, © 2010, © 2006 by Pearson Education, Inc.All Rights Reserved

Caring for Frail Older Adults with Comorbidities

24

Gerontological Nursing, Third EditionPatricia A. Tabloski

Learning Objectives

1. Describe age-related changes that affect overall health and function and that contribute to frailty.

2. State the impact of age-related changes, including organ function and presence of comorbidities.


Learning Objectives

3. Identify risk factors of health for the older person at risk for acute care hospitalization.

4. Describe causes and unique presentation of frailty in the older person.


Learning Objectives

5. Design appropriate nursing interventions directed toward assisting older adults with frailty to regain baseline function.

6. Formulate and implement appropriate nursing interventions to care for the older person with multisystem problems.


Introduction

• The purpose of this chapter is to describe special needs of frail older persons with multiple comorbidities, the risk factors associated with functional decline, problems encountered during hospitalization, and methods to avoid these problems and improve care.


Introduction

• The medical comorbidities complicate the nursing assessment and treatment of medical conditions.


Introduction

• Frailty has also been defined as the presence of three or more of the following criteria:–Unplanned weight loss (10 lbs in the last

year)–Weakness and exhaustion–Poor endurance and energy


Introduction

• Frailty has also been defined as the presence of three or more of the following criteria:–Decline in grip strength and gait speed–Slowness–Low activity


Risks of Frailty

• A frail older person is at high risk for dependency, institutionalization, falls, injuries, hospitalization, slow recovery from illness, and mortality.

• The frail older adult is most in need of, and most likely to benefit from specialized geriatric services.


Risks of Frailty

• Often, the frail older person will suffer a rapid decline and decompensation as a result of acute illness or worsening of a chronic condition.


The Paths to Frailty

• Older persons can become frail by one or more of three pathways:–Changes of aging and loss of organ

reserve and function in the very old–Diagnosis with several chronic illnesses,

each of which alone and in combination with others can cause harmful effects on overall physiological function


The Paths to Frailty

• Older persons can become frail by one or more of three pathways:–Chronic use of medications that can

impair immunity–Existence in harmful social and

psychological environments


Cumulative Effect of Comorbidities

• Often, a frail older person will be diagnosed with several underlying chronic conditions and develop an acute condition that disrupts the stability of the chronic conditions.

• The frail older person is more at risk for poor treatment outcomes and even death because of the interaction between normal changes of aging and common illnesses associated with age.


Trajectories of Functional Decline

• Frail older adults and individuals at the end of life exhibit four distinct trajectories of functional decline:–Sudden death–Diagnosis with a terminal illness–Organ failure–Frailty


Trajectories of Functional Decline

• Those who experience entry and reentry trajectories and frailty are likely to require, but may not have access to, supportive services because of steadily diminishing reserve capacity to cope with inevitable but unpredictable acute health challenges.


Frailty and Emotional Health

• The focus of health care for the frail older person will move beyond the medical model to include how to mobilize necessities for daily care, including medications, provision of nutritious meals, transportation to healthcare appointments, and home maintenance and safety.


Frailty, Comorbidities, and Functional Status

• Many older people who have chronic conditions and disabilities lead active, productive lives, but some are more disabled and require assistance with activities of daily living.


Frailty, Comorbidities, and Functional Status

• Evidence-based therapies, sophisticated levels of interprofessional care, and careful coordination characterize the health care that is necessary to provide the quality care needed by persons with heart failure, cancer, and Alzheimer’s disease as well as other chronic illnesses.


Long-term Care

• Nurses should address problem behaviors using social and environmental modifications and creative activities, thereby preserving independence and self-esteem.


Long-term Care

• Drugs for behavioral control should be used cautiously.

• Behavioral approaches include training caregivers in therapeutic responses to resistance to care.


Acute Illness and Hospitalization

• Common causes of hospitalization include pneumonia, influenza, heart failure, ischemic heart disease, urinary tract infection, hip fracture, digestive disorders, and dehydration. Heart failure and pneumonia are the most common conditions associated with rapid readmissions.


Acute Illness and Hospitalization

• Hospital care is associated with increased use of medications, invasive procedures, diagnostic testing requiring food and fluid restriction, nosocomial infections, and occurrence of adverse events and poor outcomes to hospitalized older patients.


Palliative Care

• The use of valuable social and financial resources on inappropriate or futile medical care depletes healthcare resources, drives up costs, and results in less money that could be spent on providing appropriate healthcare treatment and quality-of-life enhancement for older persons who may improve as a result of such treatment.


Palliative Care

• Palliative care improves the quality of life of older persons and their families when facing the problems associated with life-threatening illness.

• This is achieved through prevention and relief from suffering; early identification, impeccable assessment, and treatment of pain; and recognition and treatment of other physical, psychosocial, and spiritual problems.


Conclusion

• Gerontological nurses have the potential to improve the quality of life across settings by conducting effective and holistic nursing assessments, facilitating access to programs and services, educating and empowering older persons and their families, participating in and leading multidisciplinary health teams, serving as advocates and influencing the development of public policy and reform of legislation to improve long-term health care, and conducting and applying research related to aging.


Conclusion

• Nurses in all settings should practice according to the following guidelines:–Be aware of drug interactions.–Remember that the presentation of

illness is less dramatic and more vague than in other age groups.

–Conduct holistic nursing assessments when caring for frail older adults and those with comorbidities.


Conclusion

• Nurses in all settings should practice according to the following guidelines:–Seek to access and provide the most

intensive services to those considered the most frail and those diagnosed with multiple comorbidities.

–Practice ethically according to professional standards.

–Promote healthy aging in all clinical settings.


Conclusion

• Nurses in all settings should practice according to the following guidelines:–Recognize and treat pain in older

persons.–Become expert at providing end-of-life

care.–Seek continuing education programs

and pursue advanced degrees.

tabloski ch24 lecture

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