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24.1 Healthcare Concerns and Decisions of Older Adults

As older adults live longer, there are key factors that nurses can address to make sure that this population has the tools available for healthy aging. Chronic disease management and the ability to self-manage are two factors to consider. When self-management no longer seems possible, nurses should review options regarding care and advance directives with families and caregivers. Nurses must consider healthy aging and quality of life to be the overriding goals when offering education and other interventions. Health literacy and other obstacles to receiving care, such as transportation, technological abilities, and cultural issues, should also be front of mind when providing care to this population.

24.2 Depression

While not a normal part of aging, depression is also not uncommon in older adults. Older adults have higher rates of chronic illness and loss of functional independence than younger people. They also have a general loss of independence and loss of friends and family. Lack of support from family and community, lack of resources, lack of medical care, and many other factors contribute to depression, though depression can be preventable and treatable. Nurses are well positioned to recognize when a client may be depressed or be at risk for depression. Nursing interventions include collaborative practice with other professionals and advocacy for the client and family.

24.3 Anxiety

Anxiety in older adults is complicated and can be very different than in younger adults both in presentation and in management. Anxiety may be underdiagnosed and undertreated in older adults due to various factors, such as beliefs about aging and existence of medical comorbidities. Nonetheless, anxiety is treatable with the right supports and counseling. Nursing assessment and collaboration with other professionals can lead to effective interventions for older adults experiencing anxiety. Nurses are in the best positions to be able to help clients and their families with education and interventions that can truly make a difference for those living with anxiety.

24.4 Delirium

Delirium is a complication in medical care or in cognitive status for older adults and may occur in any setting. Risk factors include changes to medications or environment, infection, or dehydration. Delirium may occur in different categories with different presentations. Each situation is unique and requires careful nursing assessment and collaborative practice with the health-care team. Nurses are the primary contacts and drivers in acknowledging and assessing for delirium as well as the nonpharmacological interventions that are very important in management, treatment, and education of family.

24.5 Alcohol Use

Problematic alcohol use in older adults and older adults with AUD are frequently underreported and more frequently left unaddressed by providers. When treatment is sought, the care must be appropriate for older adults. The pharmacology of treating withdrawal and the AUD cravings is specialized for older adults. Brief interventions can be helpful in this population to reduce quantity and frequency of alcohol intake before moving into the need for more intensive interventions.

24.6 Pain

Pain in the older adult is more challenging than in the general adult population. Every person is individual as to their pain tolerance and perception of pain. Older adults who live with a mental health concern and also experience physical discomfort need specialized care. Opioids can have different effects and can have significant side effects on older adults, particularly those with cognitive impairment. There are also many medications that are used in younger adults that are not used in older adults due to kidney function, side effects, or risks for delirium. Acetaminophen has a greater effect on older adults than it does on younger adults. All of this adds up to a very different management based on the age of the client. The goal is to treat pain while causing as few side effects as possible. Managing pain leads to a higher quality of life, but only if done in a way that maximizes independence and function for as long as possible.

24.7 Psychiatric-Mental Healthcare Nursing Interventions

Providing care for older adults with mental health concerns has its challenges, and is also rewarding. Collaboration and teamwork are keys to success in providing appropriate and outcome-driven care. Outcomes should be measurable using the SMART statement and should include appropriate and data-driven nursing interventions. Geriatric comprehensive assessment is imperative for this population and should be ongoing. The family should be included in all steps if appropriate and if the client is in agreement. Transitions of care are highly important as many avoidable errors happen during this time and the nurse can be the key to stopping these errors before they happen with care and attention to detail.


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