Miller's Nursing for Wellness in Older Adults

Miller's Nursing for Wellness in Older Adults was adapted for the Canadian audience with its focus on the older Canadian and the professional Canadian based nurse. This Canadian approach enables students and registered nurses to acquire fundamental knowledge about the health issues faced by older Canadians and the resources that this country can offer us to provide quality nursing care.
In every chapter of this textbook, students will have access to Canadian content and resources abound. The authors have showcased and shared many of the best practices that were developed and are being used in this country. In addition, they specifically added an evidence-informed nursing practice box that illustrates some of the research being done in this country. This is research that provides you and us, as Canadian nurses, with the evidence to inform our nursing practice. Evidence-informed practice is an expectation of the Canadian Nurses Association and all provincial / territorial jurisdictions.

Contents
PART 1
Older Adults and Wellness 1
CHAPTER 1
Seeing Older Adults Through the Eyes of Wellness 1
IMAGES OF AGING 1
THE RELATIONSHIP BETWEEN WELLNESS AND AGING 2
Wellness and Older Adults 2
Wellness and Nursing Care of Older Adults 2
Definitions of Aging 3
Descriptions of Successful Aging 4
ATTITUDES TOWARD AGING 5
Shifting Trends 5
Ageism 5
Effects of Ageism 6
Addressing Attitudes of Nurses 8
DEBUNKING MYTHS: UNDERSTANDING REALITIES ABOUT OLDER ADULTS IN THE CANADA 8
Demographics of Aging 9
Health Characteristics 11
Socioeconomic Characteristics 11
Living Arrangements of Older Adults 13
OLDER ADULTS IN FAMILIES 14
Trends in Caregiving 14
Older Adults as Recipients and Givers of Care 15
Grandparents Raising Grandchildren 16
OLDER ADULTS IN THE WORLD 16
CHAPTER 2
Addressing Diversity of Older Adults 20
CULTURAL DIVERSITY IN CANADA 20
CULTURAL COMPETENCE 21
Performing a Cultural Self-Assessment 21
Obtaining Information About Culturally Diverse Groups 22
Linguistic Competence in Care of Older Adults 23
CULTURAL PERSPECTIVES ON WELLNESS 23
HEALTH DISPARITIES 24
OVERVIEW OF CULTURAL GROUPS OF OLDER ADULTS IN CANADA 26
 Canadian Aboriginals 26
 South Asian Canadians27
Southeast Asians 29
 Chinese Canadians
Black Canadians 30
OLDER ADULTS IN OTHER DIVERSE GROUPS 31
Older Adults in Rural Areas 32
Homeless Older Adults 32
Lesbian, Gay, Bisexual, and Transgender Older Adults 32
CHAPTER 3
Applying a Nursing Model for Promoting Wellness in Older Adults 36
A NURSING THEORY FOR WELLNESS-FOCUSED CARE OF OLDER ADULTS 36
CONCEPTS UNDERLYING THE FUNCTIONAL CONSEQUENCES THEORY 37
Functional Consequences 37
Age-Related Changes and Risk Factors 39
Person 40
Nursing 41
Health 41
Environment 42
APPLYING THE THEORY TO PROMOTE WELLNESS IN OLDER ADULTS 42
CHAPTER 4
Theoretical Perspectives on Aging Well 45
HOW CAN WE LIVE LONG AND WELL? 45
Life Span and Life Expectancy 46
Rectangularization of the Curve and Compression of Morbidity 46
Active Life Expectancy 47
Relationships Among Aging, Disease, and Death 48
Studies of Healthy Aging 48
HOW DO WE EXPLAIN BIOLOGIC AGING? 49
Wear-and-Tear Theories 49
Cross-Linkage Theory 49
Free Radical Theory 49
Neuroendocrine and Immunity Theories 49
Genetic Theories 50
Apoptosis Theory 50
Caloric Restriction Theories 50
Conclusions About Biologic Theories and Relevance to Nurses 50
SOCIOCULTURAL PERSPECTIVES ON AGING 51
Disengagement Theory 52
Activity Theory 52
Subculture and Age Stratification Theories 52
Emerging Sociocultural Theories 53
Person–Environment Fit Theory 53
Relevance of Sociocultural Theories of Aging to Nurses 53
PSYCHOLOGICAL PERSPECTIVES ON AGING 54
Human Needs Theory 54
Life-Course and Personality Development Theories 54
Theory of Gerotranscendence 55
Theories About Gender and Aging 55
Relevance of Psychological Theories of Aging to Nurses 55
A HOLISTIC PERSPECTIVE ON AGING AND WELLNESS 56
PART 2
Nursing Considerations for Older Adults 59
CHAPTER 5
Gerontological Nursing and Health Promotion 59
GERONTOLOGY AND GERIATRICS 59
GERONTOLOGICAL NURSING 60
Gerontological Nursing Education and Practice 60
Roles for Gerontological Nurses 61
Evidence-Based Practice for Gerontological Nursing 61
HEALTH, WELLNESS, AND HEALTH PROMOTION 63
Health Promotion for Older Adults 64
Health Promotion Initiatives for Older Adults 64
Types and Examples of Health Promotion Interventions for Older Adults 65
Promotion of Physical Activity as a Nursing Intervention for Wellness 68
THE TRANSTHEORETICAL MODEL OF HEALTH PROMOTION 69
CHAPTER 6
Diverse Health Care Settings for Older Adults 75
DEVELOPMENT OF A CONTINUUM OF CARE FOR OLDER ADULTS 75
ACUTE CARE SETTINGS 77
Specialized Geriatric Acute Care Units 77
Subacute Care Units 77
Hospital-at-Home Model 77
Transitional Care Models 78
Roles for Gerontological Nurses in Acute Care Settings 78
NURSING HOME SETTINGS 78
Levels of Nursing Home Care 78
Admission to Long-Term Care 79
Trends in Nursing Home Care 79
Roles for Gerontological Nurses in Nursing Home Settings 80
NEWER MODELS OF NURSING HOME CARE 80
The Culture Change Movement 80
Evidence for Positive Outcomes With Culture Change 81
Pioneer Network 81
Assisted-Living Facilities 81
Roles for Nurses in Newer Models of Care 82
HOME CARE SERVICES 82
Trends in Home Care Services 82
Skilled Home Care 83
Long-Term Home Care 83
Sources of Home Care Services 83
COMMUNITY-BASED SERVICES FOR OLDER ADULTS 84
Adult Day Centres 84
Respite Services 85
Parish Nursing Programs 85
Health Promotion Programs 85
Roles for Gerontological Nurses in Home and Community Settings 85
MODELS ADDRESSING COORDINATION OF CARE 86
Comprehensive Models 86
Chronic Care Models 87
Care and Case Management Services 87
PAYING FOR HEALTH CARE SERVICES FOR OLDER ADULTS 88
Out-of-Pocket Expenses 88
Medicare 88
Medigap Insurance 88
89
 90
Long-Term Care Insurance 90
CHAPTER 7
Assessment of Health and Functioning 94
ASSESSING HEALTH OF OLDER ADULTS 94
NURSING ASSESSMENT TOOLS 95
ASSESSING FUNCTION OF OLDER ADULTS 95
Using Functional Assessment Tools 95
Assessing Activities of Daily Living 99
Assessing Instrumental Activities of Daily Living 101
Assessing Function in Cognitively Impaired Older Adults 101
Assessing the Use or Potential Use of Adaptive and Assistive Devices 105
COMPREHENSIVE GERIATRIC ASSESSMENTS 106
ASSESSING OLDER ADULTS IN RELATION TO THEIR ENVIRONMENTS 106
ASSESSING AND ADDRESSING DRIVING SAFETY 108
Identifying Risks and Consequences 108
Addressing Risk Factors 109
Referring to Community Resources 109
Working With Caregivers 110
CHAPTER 8
Medications and Other Bioactive Substances 113
INTRODUCTION TO BIOACTIVE SUBSTANCES 113
Considerations Regarding Medications 113
Considerations Regarding Herbs and Homeopathy 115
AGE-RELATED CHANGES THAT AFFECT BIOACTIVE SUBSTANCES IN OLDER ADULTS 118
Changes That Affect the Action of Bioactive Substances in the Body 118
Changes That Affect Behaviours Related to Taking Bioactive Substances 120
RISK FACTORS THAT AFFECT BIOACTIVE SUBSTANCES 120
Pathologic Processes and Functional Impairments 121
Behaviours Based on Myths and Misunderstandings 121
Communication Barriers 122
Lack of Information 122
Inappropriate Prescribing Practices 122
Polypharmacy and Inadequate Monitoring of Medications 124
Medication Nonadherence 124
Financial Concerns Related to Prescription Drugs 124
Insufficient Recognition of Adverse Medication Effects 125
MEDICATION INTERACTIONS 125
Medication–Medication Interactions 125
Medications and Herbs 126
Medications and Nutrients 127
Medications and Alcohol 128
Medications and Caffeine 128
Medications and Nicotine 128
FUNCTIONAL CONSEQUENCES ASSOCIATED WITH BIOACTIVE SUBSTANCES IN OLDER ADULTS 129
Altered Therapeutic Effects 129
Increased Potential for Adverse Effects 129
Anticholinergic Adverse Effects 130
Altered Mental Status 130
Tardive Dyskinesia and Drug-Induced Parkinsonism 131
Antipsychotics in People With Dementia 131
NURSING ASSESSMENT OF MEDICATION USE AND EFFECTS 131
Communication Techniques for Obtaining Accurate Information 132
Scope of a Medication Assessment 132
Observing Patterns of Medication Use 134
Linking the Medication Assessment to the Overall Assessment 135
Identifying Adverse Medication Effects 135
NURSING DIAGNOSIS 136
PLANNING FOR WELLNESS OUTCOMES 136
NURSING INTERVENTIONS TO PROMOTE HEALTHY MEDICATION-TAKING PATTERNS 136
Implementing Evidence-Based Interventions 136
Teaching About Medications 137
Teaching About Herbs and Other Bioactive Substances 138
Addressing Factors That Affect Adherence 139
Decreasing the Number of Medications 141
EVALUATING EFFECTIVENESS OF NURSING INTERVENTIONS 142
CHAPTER 9
Legal and Ethical Concerns 149
AUTONOMY AND RIGHTS 149
Competency 150
Decision-Making Capacity 150
ADVANCE DIRECTIVES 151
Living Wills and Do Not Resuscitate (DNR) Orders 152
Durable Power of Attorney for Health Care 152
LEGAL ISSUES SPECIFIC TO LONG-TERM CARE SETTINGS 153
ETHICAL ISSUES COMMONLY ADDRESSED IN GERONTOLOGICAL NURSING 153
Ethical Issues in Everyday Care of Older Adults 153
Ethical Issues Specific to Long-Term Care Settings 154
Ethical Issues Related to Artificial Nutrition and Hydration 154
CULTURAL ASPECTS OF LEGAL AND ETHICAL ISSUES 155
ROLE OF NURSES REGARDING LEGAL AND ETHICAL ISSUES 156
Implementing Advance Directives 156
Facilitating Decisions About Care 158
CHAPTER 10
Elder Abuse and Neglect 162
OVERVIEW OF ELDER ABUSE AND NEGLECT 162
Characteristics of Elder Abuse 162
Historical Recognition of a Social Problem 163
Prevalence and Causes 163
Cultural Considerations 164
RISK FACTORS FOR ELDER ABUSE AND NEGLECT 165
Invisibility and Vulnerability 165
Psychosocial Factors 165
Caregiver Factors 165
ELDER ABUSE AND NEGLECT IN NURSING HOMES 166
FUNCTIONAL CONSEQUENCES ASSOCIATED WITH ELDER ABUSE AND NEGLECT 167
NURSING ASSESSMENT OF ABUSED OR NEGLECTED OLDER ADULTS 168
Unique Aspects of Elder Abuse Assessment 168
Physical Health 169
Activities of Daily Living 171
Psychosocial Function 171
Support Resources 172
Environmental Influences 172
Threats to Life 173
Cultural Aspects 173
NURSING DIAGNOSIS 174
PLANNING FOR WELLNESS OUTCOMES 175
NURSING INTERVENTIONS TO ADDRESS ELDER ABUSE AND NEGLECT 175
Interventions in Institutional Settings 175
Interventions in Community Settings 176
Interventions in Interprofessinal Teams 176
Referrals 177
Prevention and Treatment Interventions 177
LEGAL INTERVENTIONS 178
Adult Protective Services 179
Ethical Issues 181
EVALUATING EFFECTIVENESS OF NURSING INTERVENTIONS 182
PART 3
Promoting Wellness in Psychosocial Function 187
CHAPTER 11
Cognitive Function 187
AGE-RELATED CHANGES THAT AFFECT COGNITION 187
Central Nervous System 188
Fluid and Crystallized Intelligence 189
Memory 189
Adult Psychological Development 190
RISK FACTORS THAT AFFECT COGNITIVE WELLNESS 191
Personal, Social, and Attitudinal Influences 191
Physical and Mental Health Factors 192
Medication Effects 192
Smoking and Environmental Factors 192
FUNCTIONAL CONSEQUENCES AFFECTING COGNITIVE FUNCTION 193
NURSING ASSESSMENT OF COGNITIVE FUNCTION 193
NURSING DIAGNOSIS 194
PLANNING FOR WELLNESS OUTCOMES 194
NURSING INTERVENTIONS TO PROMOTE COGNITIVE WELLNESS 194
Teaching About Memory and Cognition 195
Improving Concentration and Attention 195
Encouraging Participation in Mentally Stimulating Activities 195
Adapting Health Education Materials 197
EVALUATING EFFECTIVENESS OF NURSING INTERVENTIONS 198
CHAPTER 12
Psychosocial Function202
LIFE EVENTS: AGE-RELATED CHANGES AFFECTING PSYCHOSOCIAL FUNCTION 202
Retirement 203
Relocation 204
Chronic Illness and Functional Impairments 204
Decisions About Driving a Vehicle 204
Widowhood 205
Death of Friends and Family 205
Ageist Attitudes 205
THEORIES ABOUT PSYCHOSOCIAL FUNCTION IN OLDER ADULTS 206
Theories About Emotional Development During Later Adulthood 206
Theories About Stress 206
Theories About Coping 207
FACTORS THAT INFLUENCE PSYCHOSOCIAL FUNCTION IN OLDER ADULTS 208
Religion and Spirituality 208
Cultural Considerations 209
RISK FACTORS THAT AFFECT PSYCHOSOCIAL FUNCTION 211
FUNCTIONAL CONSEQUENCES ASSOCIATED WITH PSYCHOSOCIAL FUNCTION IN OLDER ADULTS 212
NURSING ASSESSMENT OF PSYCHOSOCIAL FUNCTION 212
NURSING DIAGNOSIS 212
PLANNING FOR WELLNESS OUTCOMES 213
NURSING INTERVENTIONS TO PROMOTE HEALTHY PSYCHOSOCIAL FUNCTION 213
Enhancing Self-Esteem 214
Promoting a Sense of Control 215
Involving Older Adults in Decision Making 215
Addressing Role Loss 216
Encouraging Life Review and Reminiscence 216
Fostering Social Supports 217
Addressing Spiritual Needs 217
Promoting Wellness Through Healthy Aging Classes 218
EVALUATING THE EFFECTIVENESS OF NURSING INTERVENTIONS 221
CHAPTER 13
Psychosocial Assessment226
OVERVIEW OF PSYCHOSOCIAL ASSESSMENT OF OLDER ADULTS 226
Purposes of the Psychosocial Assessment Process 227
Procedure for the Psychosocial Assessment 227
Scope of the Psychosocial Assessment 228
COMMUNICATION SKILLS FOR PSYCHOSOCIAL ASSESSMENT 229
Identifying Communication Barriers 229
Enhancing Communication With Older Adults 230
Creating an Environment That Supports Good Communication 231
MENTAL STATUS ASSESSMENT 233
Physical Appearance 234
Motor Function and Psychomotor Behaviours 234
Social Skills 235
Response to the Interview 235
Orientation 235
Alertness and Attention 236
Memory 236
Speech and Language Characteristics 237
Higher Language Skills 238
DECISION-MAKING AND EXECUTIVE FUNCTION 238
AFFECTIVE FUNCTION 240
Guidelines for Assessing Affective Function 240
Mood 241
Anxiety 241
Self-Esteem 242
Depression 243
Happiness and Well-Being 243
CONTACT WITH REALITY 244
Delusions 244
Hallucinations and Illusions 247
Special Considerations for Assessing Contact With Reality in Older Adults 249
SOCIAL SUPPORTS 249
Social Network 250
Barriers to Obtaining Social Supports 251
Economic Resources 251
RELIGION AND SPIRITUALITY 251
CHAPTER 14
Impaired Cognitive Function: Delirium and Dementia 255
DELIRIUM 255
Overview and Types 255
Prevalence, Risk Factors, and Functional Consequences of Delirium 256
Nursing Assessment of Delirium 256
Nursing Diagnosis and Outcomes 257
Nursing Interventions for Delirium 257
OVERVIEW OF DEMENTIA 259
Terminology to Describe Dementia 259
Theories to Explain Dementia 259
Diagnosing Dementia 260
TYPES OF DEMENTIA 260
Alzheimer’s Disease 261
Vascular Dementia 263
Lewy Body Dementia 264
Frontotemporal Dementia 264
FACTORS ASSOCIATED WITH DEMENTIA 264
FUNCTIONAL CONSEQUENCES ASSOCIATED WITH DEMENTIA IN OLDER ADULTS 265
Stages of Dementia 265
Self-awareness of People With Dementia 266
Personal Experiences of Dementia 266
Behavioural and Psychological Symptoms of Dementia 268
NURSING ASSESSMENT OF DEMENTIA IN OLDER ADULTS 269
Factors That Interfere With the Assessment of Dementia 269
Initial Assessment 269
Ongoing Assessment of Consequences 269
NURSING DIAGNOSIS 270
PLANNING FOR WELLNESS OUTCOMES 271
NURSING INTERVENTIONS TO ADDRESS DEMENTIA 271
Promoting Wellness for People With Dementia 273
Theoretical Frameworks for Nursing Interventions 273
General Principles of Nursing Interventions in Different Settings 273
Improving Safety and Function Through Environmental Modifications 275
Communicating With Older Adults With Dementia 276
Teaching About Pharmacologic Interventions 276
EVALUATING THE EFFECTIVENESS OF NURSING INTERVENTIONS 279
CHAPTER 15
Impaired Affective Function: Depression 287
THEORIES ABOUT LATE-LIFE DEPRESSION 287
Psychosocial Theories 287
Cognitive Triad Theory 289
Biologic and Genetic Theories 289
Theories About Depression and Dementia 289
CLASSIFICATION OF DEPRESSION 290
RISK FACTORS FOR DEPRESSION IN OLDER ADULTS 290
Demographic Factors and Psychosocial Influences 290
Medical Conditions and Functional Impairments 291
Effects of Medications and Alcohol 292
FUNCTIONAL CONSEQUENCES ASSOCIATED WITH DEPRESSION IN OLDER ADULTS 292
Physical Health and Functioning 292
Psychosocial Function and Quality of Life 293
NURSING ASSESSMENT OF DEPRESSION IN OLDER ADULTS 294
Identifying the Unique Manifestations of Depression 294
Using Screening Tools 295
NURSING DIAGNOSIS 296
PLANNING FOR WELLNESS OUTCOMES 296
NURSING INTERVENTIONS TO ADDRESS DEPRESSION 296
Alleviating Risk Factors 297
Improving Psychosocial Function 297
Promoting Health Through Physical Activity and Nutrition 297
Providing Education and Counseling 298
Facilitating Referrals for Psychosocial Therapies 299
Teaching About and Managing Antidepressant Medications 299
Teaching About Electroconvulsive Therapy 301
Teaching About Complementary and Alternative Interventions 302
EVALUATING THE EFFECTIVENESS OF NURSING INTERVENTIONS 302
SUICIDE 302
Assessing the Risks for Suicide 303
Nursing Diagnosis and Outcomes 305
Nursing Interventions for Preventing Suicide 305
Evaluating the Effectiveness of Nursing Interventions 305
PART 4
Promoting Wellness in Physical Function 311
CHAPTER 16
Hearing 311
AGE-RELATED CHANGES THAT AFFECT HEARING 311
External Ear 311
Middle Ear 312
Inner Ear 313
Auditory Nervous System 314
RISK FACTORS THAT AFFECT HEARING WELLNESS 314
Lifestyle and Environmental Factors 314
Impacted Cerumen 315
Medication Effects 315
Disease Processes 316
FUNCTIONAL CONSEQUENCES AFFECTING HEARING WELLNESS 316
Effects on Communication 316
Effects of Hearing Loss on Overall Wellness 317
PATHOLOGIC CONDITION AFFECTING HEARING: TINNITUS 318
NURSING ASSESSMENT OF HEARING 318
Interviewing About Hearing Changes 318
Observing Behavioural Cues 320
Using Hearing Assessment Tools 320
NURSING DIAGNOSIS 321
PLANNING FOR WELLNESS OUTCOMES 322
NURSING INTERVENTIONS FOR HEARING WELLNESS 322
Promoting Hearing Wellness for All Older Adults 322
Preventing and Alleviating Impacted Cerumen 323
Compensating for Hearing Deficits 323
Communicating With Hearing-Impaired Older Adults 328
EVALUATING EFFECTIVENESS OF NURSING INTERVENTIONS 329
CHAPTER 17
Vision 333
AGE-RELATED CHANGES THAT AFFECT VISION 333
Eye Appearance and Tear Ducts 333
The Eye 335
The Retinal–Neural Pathway 336
EFFECTS OF AGE-RELATED CHANGES ON VISION 336
Loss of Accommodation 337
Diminished Acuity 337
Delayed Dark and Light Adaptation 337
Increased Glare Sensitivity 337
Reduced Visual Field 337
Diminished Depth Perception 337
Altered Color Vision 338
Diminished Critical Flicker Fusion 338
Slower Visual Information Processing 338
RISK FACTORS THAT AFFECT VISUAL WELLNESS 338
FUNCTIONAL CONSEQUENCES AFFECTING VISUAL WELLNESS 339
Effects on Safety and Function 339
Effects on Quality of Life 340
Effects on Driving 340
PATHOLOGIC CONDITIONS AFFECTING VISION 341
Cataracts 341
Age-Related Macular Degeneration 343
Glaucoma 343
NURSING ASSESSMENT OF VISION 345
Interviewing About Vision Changes 345
Identifying Opportunities for Health Promotion 345
Observing Cues to Visual Function 346
Using Standard Vision Tests 347
NURSING DIAGNOSIS 348
PLANNING FOR WELLNESS OUTCOMES 348
NURSING INTERVENTIONS FOR VISUAL WELLNESS 348
Health Promotion for Visual Wellness 348
Comfort Measures for Dry Eyes 350
Environmental Modifications 350
Low-Vision Aids 350
Maintaining and Improving the Quality of Life 351
EVALUATING EFFECTIVENESS OF NURSING INTERVENTIONS 353
CHAPTER 18
Digestion and Nutrition 358
AGE-RELATED CHANGES THAT AFFECT DIGESTION AND EATING PATTERNS 358
Smell and Taste 358
Oral Cavity 359
Esophagus and Stomach 360
Intestinal Tract 360
Liver, Pancreas, and Gallbladder 360
AGE-RELATED CHANGES IN NUTRITIONAL REQUIREMENTS 360
Calories 361
Protein 361
Carbohydrates and Fiber 361
Fats 361
Water 361
RISK FACTORS THAT AFFECT DIGESTION AND NUTRITION 362
Conditions Related to Oral Care 363
Functional Impairments and Disease Processes 363
Medication Effects 364
Lifestyle Factors 364
Psychosocial Factors 365
Cultural and Socioeconomic Factors 365
Environmental Factors 366
Behaviours Based on Myths and Misunderstandings 367
FUNCTIONAL CONSEQUENCES AFFECTING DIGESTION AND NUTRITION 367
Ability to Procure, Prepare, and Enjoy Food 367
Changes in Oral Function 367
Nutritional Status and Weight Changes 368
Quality of Life 368
PATHOLOGIC CONDITIONS AFFECTING DIGESTIVE WELLNESS: CONSTIPATION 369
NURSING ASSESSMENT OF DIGESTION AND NUTRITION 369
Interviewing About Digestion and Nutrition 369
Observing Cues to Digestion and Nutrition 370
Using Physical Assessment and Laboratory Information 370
Using Assessment Tools 371
NURSING DIAGNOSIS 372
PLANNING FOR WELLNESS OUTCOMES 374
NURSING INTERVENTIONS TO PROMOTE HEALTHY DIGESTION AND NUTRITION 374
Addressing Risk Factors That Interfere With Digestion and Nutrition 374
Promoting Oral and Dental Health 375
Promoting Optimal Nutrition and Preventing Disease 376
EVALUATING EFFECTIVENESS OF NURSING INTERVENTIONS 377
CHAPTER 19
Urinary Function 383
AGE-RELATED CHANGES THAT AFFECT URINARY WELLNESS 383
Changes in the Kidneys 383
Changes in the Bladder and Urinary Tract 385
Changes in Control Mechanisms 385
Changes Affecting Control Over Socially Appropriate Urinary Elimination 386
RISK FACTORS THAT AFFECT URINARY WELLNESS 386
Behaviours Based on Myths and Misunderstandings 386
Functional Impairments 387
Pathologic Conditions 387
Medication Effects 388
Environmental Factors 388
FUNCTIONAL CONSEQUENCES AFFECTING URINARY WELLNESS 389
Effects on Homeostasis 389
Effects on Voiding Patterns 389
PATHOLOGIC CONDITION AFFECTING URINARY FUNCTION: URINARY INCONTINENCE 390
NURSING ASSESSMENT OF URINARY FUNCTION 391
Talking With Older Adults About Urinary Function 391
Identifying Opportunities for Health Promotion 392
Using Laboratory Information 393
NURSING DIAGNOSIS 395
PLANNING FOR WELLNESS OUTCOMES 395
NURSING INTERVENTIONS TO PROMOTE HEALTHY URINARY FUNCTION 395
Teaching About Urinary Wellness 395
Promoting Continence and Alleviating Incontinence 396
Managing Incontinence 401
EVALUATING EFFECTIVENESS OF NURSING INTERVENTIONS 402
CHAPTER 20
Cardiovascular Function 408
AGE-RELATED CHANGES THAT AFFECT CARDIOVASCULAR FUNCTION 408
Myocardium and Neuroconduction Mechanisms 409
Vasculature 410
Baroreflex Mechanisms 410
RISK FACTORS THAT AFFECT CARDIOVASCULAR FUNCTION 410
Atherosclerosis 411
Physical Inactivity 411
Tobacco Smoking 412
Dietary Habits 412
Obesity 412
Hypertension 412
Lipid Disorders 413
Metabolic Syndrome 414
Psychosocial Factors 414
Heredity and Socioeconomic Factors 415
Risk for Cardiovascular Disease in Women and Minority Groups 415
FUNCTIONAL CONSEQUENCES AFFECTING CARDIOVASCULAR WELLNESS 416
Effects on Cardiac Function 416
Effects on Pulse and Blood Pressure 416
Effects on the Response to Exercise 416
Effects on Circulation 416
PATHOLOGIC CONDITIONS AFFECTING CARDIOVASCULAR WELLNESS: ORTHOSTATIC AND POSTPRANDIAL HYPOTENSION 417
NURSING ASSESSMENT OF CARDIOVASCULAR FUNCTION 417
Assessing Baseline Cardiovascular Function 418
Assessing Blood Pressure 418
Identifying Risks for Cardiovascular Disease 418
Assessing Signs and Symptoms of Heart Disease 419
Assessing Knowledge About Heart Disease 422
NURSING DIAGNOSIS 422
PLANNING FOR WELLNESS OUTCOMES 423
NURSING INTERVENTIONS TO PROMOTE HEALTHY CARDIOVASCULAR FUNCTION 423
Addressing Risks Through Nutrition and Lifestyle Interventions 423
Secondary Prevention 424
Addressing Risks Through Pharmacologic Interventions 425
Preventing and Managing Hypertension 425
Preventing and Managing Lipid Disorders 428
Preventing and Managing Orthostatic or Postprandial Hypotension 429
EVALUATING EFFECTIVENESS OF NURSING INTERVENTIONS 429
CHAPTER 21
Respiratory Function 435
AGE-RELATED CHANGES THAT AFFECT RESPIRATORY FUNCTION 435
Upper Respiratory Structures 435
Chest Wall and Musculoskeletal Structures 436
Lung Structure and Function 437
RISK FACTORS THAT AFFECT RESPIRATORY WELLNESS 438
Tobacco Use 438
Secondhand Smoke and Other Environmental Factors 439
Additional Risk Factors for Compromised Respiratory Function 439
FUNCTIONAL CONSEQUENCES AFFECTING RESPIRATORY WELLNESS 440
PATHOLOGIC CONDITION AFFECTING RESPIRATORY FUNCTION: COPD 441
NURSING ASSESSMENT OF RESPIRATORY FUNCTION 441
Identifying Opportunities for Health Promotion 441
Detecting Lower Respiratory Infections 442
Assessing Smoking Behaviours 443
Identifying Other Risk Factors 444
Physical Assessment Findings 444
NURSING DIAGNOSIS 445
PLANNING FOR WELLNESS OUTCOMES 445
NURSING INTERVENTIONS FOR RESPIRATORY WELLNESS 445
Promoting Respiratory Wellness 445
Preventing Lower Respiratory Infections 446
Eliminating the Risk From Smoking 447
EVALUATING EFFECTIVENESS OF NURSING INTERVENTIONS 448
CHAPTER 22
Mobility and Safety 452
AGE-RELATED CHANGES THAT AFFECT MOBILITY AND SAFETY 452
Bones 452
Muscles 453
Joints and Connective Tissue 454
Nervous System 454
Osteopenia and Osteoporosis 454
RISK FACTORS THAT AFFECT MOBILITY AND SAFETY 454
Risk Factors That Affect Overall Musculoskeletal Function 455
Risk Factors for Osteoporosis and Osteoporotic Fractures 455
Risk Factors for Falls 456
PATHOLOGIC CONDITION AFFECTING MUSCULOSKELETAL FUNCTION: OSTEOARTHRITIS 458
FUNCTIONAL CONSEQUENCES AFFECTING MUSCULOSKELETAL WELLNESS 459
Effects on Musculoskeletal Function 459
Susceptibility to Falls and Fractures 459
Fear of Falling 460
NURSING ASSESSMENT OF MUSCULOSKELETAL FUNCTION 460
Assessing Musculoskeletal Performance 460
Identifying Risks for Osteoporosis 461
Identifying Risks for Falls and Injury 462
NURSING DIAGNOSIS 464
PLANNING FOR WELLNESS OUTCOMES 464
NURSING INTERVENTIONS FOR MUSCULOSKELETAL WELLNESS 464
Promoting Healthy Musculoskeletal Function and Preventing Falls 464
Health Education About Osteoporosis 465
Preventing Falls and Fall-Related Injuries 467
EVALUATING EFFECTIVENESS OF NURSING INTERVENTIONS 471
CHAPTER 23
Integument 477
AGE-RELATED CHANGES THAT AFFECT THE SKIN 477
Epidermis 477
Dermis 479
Subcutaneous Tissue and Cutaneous Nerves 479
Sweat and Sebaceous Glands 479
Nails 479
Hair 479
RISK FACTORS THAT AFFECT SKIN WELLNESS 480
Genetic Influences 480
Lifestyle and Environmental Influences 480
Medication Effects 480
FUNCTIONAL CONSEQUENCES AFFECTING SKIN WELLNESS 481
Susceptibility to Injury 481
Response to Ultraviolet Radiation 481
Comfort and Sensation 481
Cosmetic Effects 481
PATHOLOGIC CONDITIONS AFFECTING SKIN: SKIN CANCER AND PRESSURE ULCERS 482
Skin Cancer 482
Pressure Ulcers 483
NURSING ASSESSMENT OF SKIN 487
Identifying Opportunities for Health Promotion 487
Observing Skin, Hair, and Nails 487
NURSING DIAGNOSIS 490
PLANNING FOR WELLNESS OUTCOMES 490
NURSING INTERVENTIONS FOR SKIN WELLNESS 491
Promoting Healthy Skin 491
Preventing Skin Wrinkles 491
Preventing Dry Skin 492
Detecting and Treating Harmful Skin Lesions 492
EVALUATING EFFECTIVENESS OF NURSING INTERVENTIONS 492
CHAPTER 24
Sleep and Rest 496
AGE-RELATED CHANGES THAT AFFECT SLEEP AND REST PATTERNS 496
Sleep Quantity 497
Sleep Quality 498
Circadian Rhythm 498
RISK FACTORS THAT CAN AFFECT SLEEP 499
Psychosocial Factors 499
Environmental Factors 499
Pathophysiologic Factors 500
Effects of Bioactive Substances 500
FUNCTIONAL CONSEQUENCES AFFECTING SLEEP WELLNESS 501
PATHOLOGIC CONDITION AFFECTING SLEEP: OBSTRUCTIVE SLEEP APNEA 502
NURSING ASSESSMENT OF SLEEP 503
Identifying Opportunities for Health Promotion 503
Evidence-Based Assessment Tools 503
NURSING DIAGNOSIS 504
PLANNING FOR WELLNESS OUTCOMES 504
NURSING INTERVENTIONS FOR SLEEP WELLNESS 504
Evidence-Based Interventions 504
Self-Care Actions to Promote Healthy Sleep Patterns 505
Complementary and Alternative Care Practices 505
Improving Sleep for Older Adults in Institutional Settings 506
Modifying the Environment to Promote Sleep 507
Educating Older Adults About Medications and Sleep 507
Teaching About Management of Sleep Disorders 507
EVALUATING EFFECTIVENESS OF NURSING INTERVENTIONS 509
CHAPTER 25
Thermoregulation513
AGE-RELATED CHANGES THAT AFFECT THERMOREGULATION 513
Response to Cold Temperatures 513
Response to Hot Temperatures 515
Normal Body Temperature and Febrile Response to Illness 515
RISK FACTORS THAT AFFECT THERMOREGULATION 515
Pathophysiologic Conditions That Alter Thermoregulation 515
Environmental and Socioeconomic Influences 515
Behaviours Based on Lack of Knowledge 516
FUNCTIONAL CONSEQUENCES ASSOCIATED WITH THERMOREGULATION IN OLDER ADULTS 516
Altered Response to Cold Environments 517
Altered Response to Hot Environments 517
Altered Thermoregulatory Response to Illness 517
Altered Perception of Environmental Temperatures 517
Psychosocial Consequences of Altered Thermoregulation 517
NURSING ASSESSMENT OF THERMOREGULATION 518
Assessing Baseline Temperature 518
Identifying Risk Factors for Altered Thermoregulation 518
Assessing for Hypothermia 519
Assessing for Hyperthermia 519
Assessing the Older Adult’s Febrile Response to Illness 520
NURSING DIAGNOSIS 520
PLANNING FOR WELLNESS OUTCOMES 520
NURSING INTERVENTIONS TO PROMOTE HEALTHY THERMOREGULATION 520
Addressing Risk Factors 520
Promoting Healthy Thermoregulation 521
EVALUATING EFFECTIVENESS OF NURSING INTERVENTIONS 521
CHAPTER 26
Sexual Function 525
AGE-RELATED CHANGES THAT AFFECT SEXUAL FUNCTION 525
Changes Affecting Older Women 525
Changes Affecting Older Men 527
RISK FACTORS THAT AFFECT SEXUAL FUNCTION 527
Societal Influences 527
Attitudes and Behaviours of Families and Caregivers 528
Limited Opportunities for Sexual Activity 528
Adverse Effects of Medication, Alcohol, and Nicotine 529
Chronic Conditions 529
Gender-Specific Conditions 530
Functional Impairments and Dementia 530
FUNCTIONAL CONSEQUENCES AFFECTING SEXUAL WELLNESS 530
Reproductive Ability 531
Response to Sexual Stimulation 531
Sexual Interest and Activity 531
Male Sexual Dysfunction 532
Female Sexual Dysfunction 532
PATHOLOGIC CONDITION AFFECTING SEXUAL WELLNESS: HUMAN IMMUNODEFICIENCY VIRUS 533
Risk Factors for HIV 533
Role of Nurses in Assessment and Interventions 534
NURSING ASSESSMENT OF SEXUAL FUNCTION 534
Self-Assessment of Attitudes About Sexual Function and Aging 534
Assessing Sexual Function in Older Adults 535
NURSING DIAGNOSIS 537
PLANNING FOR WELLNESS OUTCOMES 537
NURSING INTERVENTIONS TO PROMOTE HEALTHY SEXUAL FUNCTION 537
Teaching Older Adults About Sexual Wellness 537
Addressing Risk Factors 537
Promoting Sexual Wellness in Long-Term Care Settings 539
Teaching Women About Interventions 539
Teaching Men About Interventions 540
EVALUATING EFFECTIVENESS OF NURSING INTERVENTIONS 541
PART 5
Promoting Wellness in All Stages of Health and Illness 547
CHAPTER 27
Caring for Older Adults During Illness 547
CHARACTERISTICS OF ILLNESS IN OLDER ADULTS 547
CONNECTING THE CONCEPTS OF WELLNESS, AGING, AND ILLNESS 548
HOLISTICALLY CARING FOR OLDER ADULTS WHO ARE ILL: FOCUSING ON CARING AND COMFORTING 549
APPLYING WELLNESS CONCEPTS IN SPECIFIC PATHOLOGIC OR CHRONIC CONDITIONS 550
Promoting Wellness for Older Adults With Cancer 550
Promoting Wellness for Older Adults With Diabetes Mellitus 552
Promoting Wellness for Older Adults With Heart Failure 553
ADDRESSING NEEDS OF FAMILIES AND CAREGIVERS 555
CHAPTER 28
Caring for Older Adults Experiencing Pain 560
ACUTE VERSUS PERSISTENT PAIN 560
ANATOMY AND PHYSIOLOGY OF PAIN 561
TYPES OF PAIN 562
CAUSES OF PAIN IN OLDER ADULTS 562
AGE-RELATED CHANGES THAT AFFECT PAIN 563
BARRIERS TO PAIN MANAGEMENT 563
FUNCTIONAL CONSEQUENCES OF PAIN IN OLDER ADULTS 563
CULTURAL ASPECTS OF PAIN ASSESSMENT AND MANAGEMENT 563
NURSING ASSESSMENT OF PAIN IN OLDER ADULTS 565
Collecting Pertinent Information 565
Assessment of Pain Components 566
Assessment in Cognitively Impaired Older Adults 568
PRINCIPLES OF ANALGESIC MEDICATION 568
Classifications of Analgesics 569
The World Health Organization’s Three-Step Pain Relief Ladder for Pain Management 570
Management of Side Effects and Risks of Tolerance, Dependence, and Addiction 571
Developing a Wellness-Focused Pain Management Plan 571
CHAPTER 29
Caring for Older Adults at the End of Life 575
THE DYING PROCESS AND DEATH 575
NURSING SKILLS FOR PALLIATIVE CARE 576
PERSPECTIVES ON DEATH AND DYING 576
Sites of Death and Dying 576
Views of Death and Dying in Western Culture 576
Older Adults’ Perspective on Death and Dying 577
Health Care Professionals’ Perspective on Death and Dying 577
Culturally Diverse Perspectives on Death and Dying 578
QUALITY OF CARE AT THE END OF LIFE 578
Promoting Wellness at the End of Life 579
Hospice Care 580
NURSING INTERVENTIONS IN END-OF-LIFE CARE 581
Promoting Communication 581
Offering Spiritual Support 581
Managing Symptoms 582
Index 589

Learning Objectives
Assessment Boxes
Interventions Boxes
Evidence-Based Practice Boxes
Cultural Considerations