Chapter 21: Care of the Older Client

Care of the Older Client begins by establishing foundational concepts in gerontology and aging, then systematically examines the physiological changes that occur across body systems with advancing age, including alterations in skin integrity, cardiovascular function, respiratory capacity, gastrointestinal processes, neurological performance, musculoskeletal strength, endocrine regulation, immune response, renal function, and sensory perception. Understanding these normal age-related changes is essential for distinguishing them from pathological conditions and for anticipating client needs. The chapter emphasizes critical safety concerns specific to older populations, particularly fall risk, temperature regulation difficulties, and vulnerability to medication-related complications. Mental health considerations receive substantial attention, with detailed guidance on recognizing depression, processing grief, identifying suicide risk, and differentiating between depression, delirium, and dementia—conditions that present differently but are often confused. Pain management is explored through both pharmacological and nonpharmacological approaches, with recognition that older adults may express pain differently and that behavioral indicators are important assessment data. Infection management addresses the reality that older adults often present with atypical symptoms, where confusion may be the primary indicator of infection rather than fever. The chapter provides critical information on medication safety, including discussion of polypharmacy dangers, the Beers Criteria for medications to avoid in older populations, and strategies for safe administration accounting for swallowing difficulties and altered pharmacokinetics. Abuse—encompassing domestic violence, institutional maltreatment, and self-neglect—is examined with attention to risk factors, reporting obligations, and protective interventions. Throughout the chapter, nursing actions emphasize maintaining dignity, supporting independence, promoting social engagement and reminiscence therapy, and individualizing care to preserve autonomy despite functional decline.