Chapter 14: Health Care Needs of Older Adults

Health Care Needs of Older Adults begins by addressing the demographics of aging and the critical need for nurses to overcome ageism and negative stereotypes, such as the misconception that cognitive decline is inevitable. The text outlines the developmental tasks specific to older adulthood, including adjusting to retirement, changes in income, and the death of spouses or friends, while stressing that each individual ages uniquely. A major focus is placed on the normal physiological changes associated with aging across all body systems, such as presbyopia and presbycusis in sensory function, decreased skin elasticity, kyphosis, reduced cardiac output, and musculoskeletal changes like osteoporosis. The chapter highlights the importance of distinguishing these normal age-related changes from pathology, noting that illness in older adults often manifests with atypical symptoms; for example, a urinary tract infection might present as confusion or incontinence rather than fever. Significant attention is given to cognitive health, specifically the differential diagnosis of delirium, dementia (including Alzheimer disease), and depression, often referred to as the "three Ds." Nursing assessment strategies are detailed, utilizing tools like the SPICES framework to identify risks related to sleep, eating, incontinence, confusion, falls, and skin breakdown. The summary also covers psychosocial concerns, including social isolation, housing decisions such as aging in place, and the continued need for sexual expression and intimacy. Health promotion strategies are extensively discussed, focusing on the management of chronic conditions like hypertension, cancer, and COPD, as well as safety issues regarding polypharmacy, fall prevention, and the detection of elder mistreatment. Finally, the chapter explores therapeutic communication techniques—such as reality orientation, validation therapy, and reminiscence—and delineates nursing interventions in acute and restorative care settings aimed at preventing complications like dehydration and pressure injuries while maximizing independence in activities of daily living (ADLs) and instrumental ADLs (IADLs).