Chapter 8: Management of the Older Adult Patient

Management of the Older Adult Patient begins by examining the demographic trends of the aging population, specifically the surge of the baby boomer generation, and distinguishes between gerontology as a multidisciplinary study and geriatrics as a medical practice. A core focus is placed on the Functional Consequences Theory, which guides nurses to differentiate between normal, irreversible age-related changes and modifiable risk factors to maintain patient independence. The text details the physiological alterations across major body systems, including cardiovascular stiffening and reduced cardiac output, respiratory declines in vital capacity, integumentary thinning leading to thermoregulation issues, and musculoskeletal losses in bone density and muscle mass. It further explores sensory changes such as presbycusis and presbyopia, alongside gastrointestinal and renal variations that impact nutrition and drug elimination. Significant attention is given to the pharmacologic aspects of aging, highlighting the risks of polypharmacy, altered pharmacokinetics (absorption, distribution, metabolism, excretion), and the utility of the Beers Criteria for identifying potentially inappropriate medications. The chapter contrasts normal cognitive aging—where fluid intelligence may decline while crystallized intelligence remains stable—with pathological conditions. It provides an in-depth analysis of mental health issues, distinguishing between the acute, reversible medical emergency of delirium and chronic, progressive dementias like Alzheimer's disease and vascular dementia. Furthermore, the text addresses geriatric syndromes, a group of multifactorial conditions including falls, urinary incontinence, and dizziness, while emphasizing the phenomenon of atypical presentation of illness in older adults, where infection may manifest as confusion rather than fever. Finally, the chapter covers essential psychosocial and ethical components of care, including the combatting of ageism, diverse living arrangements from aging in place to continuing care retirement communities, the detection of elder abuse and neglect, and the legal importance of advance directives and proxy decision-making.