Chapter 20: Care of the Older Client

The integumentary system experiences significant deterioration, including thinning skin, decreased elasticity, and reduced thermoregulation, necessitating careful attention to skin integrity and temperature management. Neurological changes manifest as slower reflexes and diminished fine motor coordination, though cognitive decline varies individually. Musculoskeletal alterations, particularly decreased bone density and muscle mass, substantially elevate fracture and fall risk, especially in postmenopausal individuals experiencing osteoporosis. Cardiovascular and respiratory systems show reduced efficiency, with decreased cardiac compliance, increased susceptibility to postural hypotension, and weakened respiratory muscles that compromise coughing effectiveness and increase infection vulnerability. Sensory changes are widespread, affecting vision through presbyopia and cataracts, hearing loss particularly for high frequencies, and diminished taste, smell, and pain perception. Gastrointestinal and renal functions slow considerably, leading to constipation and reduced medication clearance that increases toxicity risk. The chapter emphasizes critical distinctions between delirium, dementia, and depression, conditions frequently confused but requiring different interventions. Infection presents atypically in older adults, with altered mental status serving as a primary indicator rather than fever. Effective pain management must balance pharmacological and nonpharmacological approaches while recognizing that older clients often underreport discomfort. Medication safety is paramount, with standard dosages requiring reduction to one-third or one-half normal strength due to altered pharmacokinetics and potential polypharmacy complications. The Beers Criteria provides guidance for medications to avoid in this population. The chapter also addresses elder mistreatment in various settings, identifying risk factors and establishing nursing protocols for reporting and intervention while maintaining client confidentiality and safety planning.