Aging is an inevitable and natural process. It’s a phase of life that everyone must navigate at their own pace. According to the Gale Encyclopedia of Medicine, the aging process typically begins in middle age, around 40, as the body starts to show the effects of daily wear and tear.

With aging, bones tend to shrink in size and density, weakening them and making them more susceptible to fracture.  Muscles generally lose strength, endurance, and flexibility. These factors can affect your coordination, stability, and balance.

The bladder may become less elastic with aging, resulting in the need to urinate more often. Weakening of bladder and pelvic floor muscles may make it difficult to empty your bladder or cause you to lose bladder control (urinary incontinence). In men, an enlarged or inflamed prostate can also cause difficulty emptying the bladder and incontinence.

With age, the skin thins and becomes less elastic and more fragile, and fatty tissue below the skin decreases. Bruising may be noticed more easily and quickly. Decreased production of natural oils might make the skin drier. Wrinkles, age spots, and small growths called skin tags are more common.

With aging, information processing slows down, and older people have more trouble multitasking. Characteristics that increase the risk of becoming a victim of abuse include functional dependence/disability, poor physical health, cognitive impairment, poor mental health, and low income.

Cognitive impairment and poor physical health are the major reason that leads to elder abuse, as they might not be able to protect themselves.

Nursing assessment is a significant part of the elderly’s care. Geriatric assessment should include a detailed medical history and physical examination, focusing on problems specific to the elderly, such as vision, hearing impairment, fall prevention, urinary incontinence, osteoporosis, and preventative health. Consideration should be given to physical assessment to check the skin tone and color and check for pressure ulcers around pressure points.

Medication reconciliation and avoidance of polypharmacy are essential in every visit or each transition of care. Similarly, falls are one of the significant causes of disability and morbidity in the elderly. It is necessary to assess for falls and discuss ways to prevent them during each visit.

 It is also essential to know that elderly abuse can affect anyone, no matter the person’s age, sex, race, religion, or ethnic or cultural background. Hundreds of thousands of adults over 60 are abused, neglected, or financially exploited each year. Although most victims of abuse are women, some men are also victims. The likely targets are older adults with no family or friends nearby and people with disabilities, memory problems, or dementia. However, financial abuse is becoming a widespread and hard-to-detect issue. Even someone you’ve never met can steal your financial information via telephone, the internet, or email.

Nurses should perform a full assessment to obtain information regarding the patient’s current functional and instrumental activities of daily living (ADLs); gait, balance, and fall risks; visual and auditory acuity; mood, memory, executive functioning, and problem-solving; and risk for or presence of skin breakdown. A series of assessment tools may be utilized for this process. For example, the Mini-Mental State Exam (MMSE) is a validated measure of cognition. The Fulmer SPICES tool assesses older adults for sleep disturbances, problems with eating or feeding, incontinence, confusion, evidence of falls, and skin breakdown.

Also, nurses can assess for failure to thrive (FTT) in older patients, which is a syndrome of global decline consisting of weight loss, decreased appetite, poor nutrition, and inactivity that is often accompanied by dehydration, symptoms of depression, impaired immunity, and reduced cholesterol, to help identify an early sign of suspected abuse.

Nurses must pay particular attention to polypharmacy during the assessment of the aged. Older persons are often prescribed multiple medications by different healthcare providers, putting them at increased risk for drug-drug interactions and adverse drug events. The clinician should review the patient’s medications at each visit. The best method of detecting potential problems with polypharmacy is to have patients bring in all their medications (prescription and nonprescription) in their bottles. Discrepancies between what is documented in the medical record and what the patient takes must be reconciled. As health systems have moved towards electronic health records and e-prescribing, the potential to detect potential medication errors and interactions has increased substantially. Although this can improve safety, record-generated messages about unimportant or rare interactions may lead to “reminder fatigue.

Elderly patients should also be asked about alternative medical therapy. For example, herb use can be assessed by questioning: “What prescription medications, over-the-counter medicines, vitamins, herbs, or supplements do you use?

 It is essential for nurses to understand and make available end-of-life choices for patients and family members. Nurses are a vital part of end-of-life life care, with general responsibilities including assessing anxiety levels of patients and other mental and emotional states, determining levels of perceptual or cognitive impairment, as well as physical fitness, evaluating the progress of a patient’s disease or condition, and helping the families of patients to solve any issues that may result from end-of-life care. Nurses need to focus on their physical and mental health outside of patient care, and they will be better able to guide the emotions of their patients and their families.

REFERENCE:

Amarya, S., Singh, K., & Sabharwal, M. (2018). Ageing Process and Physiological Changes. In G. D’Onofrio, A. Greco, & D. Sancarlo (Eds.), Gerontology. IntechOpen. https://doi.org/10.5772/intechopen.76249

Gallo JJ, Fulmer T, Paveza GJ, Reichel W. Functional assessment. In: Gallo JJ, Bogner HR, Fulmer T, Paveza GJ, eds. Handbook of Geriatric Assessment. Sudbury, MA: Jones & Bartlett; 2000:109-110

Wolf, R. S. (2000). Introduction: The Nature and Scope of Elder Abuse. Generations: Journal of the American Society on Aging, 24(2), 6–12. http://www.jstor.org/stable/44878434