Chapter 28: Older Adults

Older Adults thoroughly examines the detrimental impacts of ageism and age discrimination within clinical settings, emphasizing the urgent need to eradicate patronizing communication styles like elderspeak to foster respect and improve patient outcomes. A core focus is placed on the comprehensive geriatric assessment, which holistically evaluates a patient's physical health, mental status, functional abilities, and complex pharmacological needs. The text highlights the critical dangers of polypharmacy and altered pharmacokinetics in aging bodies, particularly the severe cognitive risks and fall hazards associated with anticholinergic medications. Additionally, the chapter systematically breaks down prevalent psychiatric disorders in later life, with a major emphasis on clinical depression—the most common yet highly treatable condition that is frequently misdiagnosed as dementia or a normal part of aging. It details evidence-based interventions for depression, including group psychotherapy, cognitive-behavioral therapy, and carefully monitored psychopharmacology, while providing vital strategies for assessing suicide risk using specialized geriatric screening tools. Furthermore, it clearly differentiates the acute onset of delirium from the progressive cognitive decline of dementia and the mood disturbances of depression. The hidden epidemic of geriatric substance use is also explored, detailing the physiological vulnerability older adults have to alcohol, prescription painkillers, and benzodiazepines, alongside the rising rates of HIV and AIDS-related dementia in this demographic due to physiological changes and a lack of safe-sex practices. Finally, the chapter navigates complex legal and ethical issues critical to geropsychiatric nursing, including strict Joint Commission regulations against physical and chemical restraints, the implications of the Patient Self-Determination Act, and the essential role of advance directives—such as living wills, directives to physicians, and durable powers of attorney for health care—in ensuring patient autonomy and protecting the rights of all older adults during critical end-of-life decision-making.