Академический Документы
Профессиональный Документы
Культура Документы
Julianna Brauchle
Abstract
Successful aging is defined by Rowe and Kahn (1997) as possessing three main components: low
probability of disease and disease-related disability, high cognitive and physical functional
capacity, and active engagement with life. The purpose of this paper is to complete a
aging in their day to day life and recognize any problem areas in their functionality. Different
geriatric assessment tools were utilized in order to identify problem areas and to create a nursing
care plan to promote the health and wellness of the elderly individual. These problem areas
included sleep disorders and depression. Research was utilized to further develop a care plan in
order to increase the well-being of the elderly individual according to the problem areas
previously identified. This care plan includes nursing diagnoses, goals, interventions, and
evidence based rationales related to the problem areas identified during the client’s assessment,
Jane Doe, who’s name was changed in order to provide privacy, is a 92-year-old female
living in her home with her oldest daughter. Jane has lived in her home since 1946, and has no
plans of moving out. She has a history of emphysema in which she is on a continuous 2 L/min
oxygen therapy treatment for. She has a home care aide that comes in twice a week to bathe her
and clean the small area she lives in. Jane also has what she calls “extremely mild depression” (J.
Doe, personal communication, February 8, 2017), in which she is taking Paroxetine to treat.
Jane’s activities of daily living (ADL’s) were evaluated using the Katz Index of
Independence in Activities of Daily Living (ADL) (Katz, 1983) (See Appendix A for ADL
assessment). Upon evaluation, Jane scored a four out of six. Jane needs assistance with bathing
and is partially incontinent, which gave her zero points in those categories. She is able to dress
herself, is able to toilet herself, is able to transfer herself without assistance, and is able to feed
Instrumental activities of daily living (IADL’s) were assessed with Jane using the Lawton
Instrumental Activities of Daily Living Scale (Lawton & Brody, 1969) (See Appendix B for
IADL assessment). Jane scored a four out of eight on the Lawton IADL scale. She is able to
operate the telephone by herself, she does her own laundry completely, is responsible for taking
her own medication in correct dosages at the correct time, and manages her day-to-day purchases
but needs help with banking. Jane needs her meals prepared and served to her, is completely
unable to shop alone, does not travel at all, and does not participate in any housekeeping tasks.
IMPACT OF AGING ON THE ELDERLY 4
Communication
Jane does not have any impairments that prevent her from communicating. Jane has no
speech deficit and speaks loudly and clearly with ease. Her sight is intact and she demonstrates
this by reading aloud a paragraph from her newspaper without any difficulty. Jane’s hearing was
assessed using the Hearing Handicap Inventory for the Elderly Screening Version (HHIE-S)
(Ventry & Weinstein, 1983) (See Appendix C for assessment). Jane scored a 12 which suggests a
mild to moderate hearing handicap. She finds it hard to hear someone speaking in a whisper, and
finds it difficult to hear when she is in a loud restaurant, and also has arguments with family.
Economic Status
Jane did not want to share very much of her economic status. She did, however, state that
she had “no plans of moving into a long-term care facility” (J. Doe, personal communication,
February 8, 2017). She also stated that she does have a living will, and that her son is in charge
Living/Home Environment
A home safety assessment was retrieved from A Place for Mom (2015) and used to assess
Jane’s home (see Appendix D for assessment). The assessment revealed a need for improvement
that was discussed with Jane, as throw rugs created a further fall risk, along with her oxygen
tubing that is wrapped around the halls and is a big tripping hazard. Since Jane does not often
leave her home, the front entry is not an immediate danger, but in an emergent situation it would
be. Further communication with her daughter occurred and the necessary changes were noted.
Mental Health
To assess the mental health of Jane, a few different assessment tools were utilized. First,
the Mini-Cog (Borson et al., 2006) (See Appendix E for assessment and clock drawing) was
IMPACT OF AGING ON THE ELDERLY 5
used. Jane scored a two out of five on this assessment as she did not draw the correct time and
she only remembered two of the three words after the distractor. Next, the Montreal Cognitive
Assessment (Nasreddine, 1996) (See Appendix F for assessment) was used. Jane scored a 26 out
of 30. The Geriatric Depression Scale (Yesavage et al., 1982) (See Appendix G for assessment)
was then utilized to score Jane’s depression. She scored an eight out of 15 which is suggestive of
depression, as she answered each question based upon how she felt in the last week. She did not
feel happy most of the time, in fact she often felt helpless, bored, and worthless.
(Rubenstein, 2001) (See Appendix H for assessment) was utilized. She scored a seven out of 14
possible points, which is indicative of malnourishment. Jane has a BMI of 17.9, has lost about 6
pounds over the last three months, and does not go out of her house which all put her at risk for
malnutrition. However, she recently had a fall that resulted in an injury on her right leg. The
Hendrich II Fall Risk Model (Hendrich, 1995) (See Appendix I for assessment) was used to
further investigate Jane’s fall risk. She scored a six which puts her at high risk for a fall, as she is
unable to stand without multiple attempts, has symptomatic depression, and altered elimination.
Social Support
Jane’s social support, as she stated, includes her children, and her neighbors. She
occasionally finds that some of her friends come and visit her, but not on a basis to consider
them a part of her support team (J. Doe, personal communication, February 8, 2017). Her
neighbors visit her on a regular basis to check up on her, but other than them she claims she does
Sleep
IMPACT OF AGING ON THE ELDERLY 6
Jane expressed her concern with her sleep. In order to better assess her sleep patterns, two
assessments were performed. First, the Pittsburgh Sleep Quality Index (Buysse et al., 1989) (See
Appendix J for assessment) was used to measure the quality and patterns of her sleep. Jane
scored an eight, which indicates she sleeps poorly according to the Pittsburg Sleep Quality Index
(Buysse et al., 1989). Next, the Epworth Sleepiness Scale (Johns, 1991) (See Appendix K for
assessment) was used to measure average daytime sleepiness. Jane scored a 15 on this
assessment which reflects a lot of daytime sleepiness and that she should seek medical advice.
Jane can be directly quoted as saying “old age sucks… it’s exhausting. There are so many
things you want to do but can’t” (J. Doe, personal communication, February 8, 2017). Her life
has been impacted greatly by aging. Jane was once a local gym teacher, loved to dance, and
played tennis three times a week. After her emphysema really kicked in, she had to change her
lifestyle and is now no longer able to do the things she once loved to do. She also stated “all of
my tennis partners are dead now anyways, I am the only one still here. What fun would it be if I
could still play, without my friends around to play with? Getting old really is awful because it’s
lonely, all of your friends die off and you are left with only yourself” (J. Doe, personal
communication, February 8, 2017). Jane does not like the impact that aging has had on her life.
Aging has been a largely negative subject in Jane’s life. Growing older has left Jane
feeling lonely and depressed. She has been on an SSRI for three years now in an attempt to
combat her depression, however she expresses that she still cries and feels sad a lot of the time.
Jane claims that the stereotypes are true about aging. One specific stereotype that she is referring
to is that North Americans “depict later life as a time of ill health, loneliness, dependency, and
poor physical and mental functioning” (as cited in Dionigi, 2015). It has been found that “aging
IMPACT OF AGING ON THE ELDERLY 7
self-stereotypes had a direct impact on physiological function, with negative aging stereotype
primes increasing cardiovascular stress in white and African American older individuals,
respectively, before and after mental challenges” (as cited in Dionigi, 2015). Jane does not have
any cardiovascular issues, however she does have a negative self-image on her aging, which may
have had an impact on her aging process. According to Dionigi (2015), “the fear of being
perceived as sick could actually discourage people from seeking medical assistance, indicating
that the concept of stereotype threat is working in conjunction with the internalization of
negative stereotypes”. Jane has avoided seeking medical care for a fall she recently had because
she does not want to be seen as sick. Her direct quote was “I do not need to go to see a doctor for
this cut, nothing is wrong, I will heal like I have always healed- that does not change just because
I am old” (J. Doe, personal communication, February 8, 2017). The negative stereotype of aging
and being feeble led her to forego medical assistance, which can impact her health in the future.
Coping Mechanisms
Jane claims that in order to cope with her loneliness, she stays inside of her home and
watches TV or reads (J. Doe, personal communication, February 8, 2017). She also stated that
she would rather stay at home than to go out and meet new friends, because any friend she makes
that is her own age is probably going to die soon anyway, so what’s the point (J. Doe, personal
“maladaptive coping mechanisms more commonly used in depressed older adults” (Raut et al.,
2014). According to the Raut et al. (2014) study, “considerable variation is seen among the
coping strategies which are used by the lonely and the choices of coping strategies are affected
by the individuals age, life experience, cultural background, and the availability methods of
alleviating loneliness”. This same study also claims that “common coping strategies used by
IMPACT OF AGING ON THE ELDERLY 8
elderly include active solitude, social contact, sad passivity, increased activity distancing, and
denial” (Raut et al., 2014). Jane has displayed the use of these maladaptive coping mechanisms
quite clearly. She chooses to live in solitude, as she would rather be alone than feel the pain of
losing another friend. She distances herself from other people out of fear of losing them, and she
To Jane, successful aging is “not being sick, being able to hold an intellectual
conversation, and not to feel like I am dying every day of my life” (J. Doe, personal
communication, February 8, 2017). She feels as though she has successfully aged in the sense
that she is able to hold an intellectual conversation and talk to a person without forgetting too
much, but her emphysema is her sickness and it prevents her from feeling good every day. She
claims that she doesn’t feel as though she is dying every day, but most days she wishes she
Problem Areas
The first of two main problem areas in relation to Jane is her sleep pattern. Upon
evaluation by both the Pittsburgh Sleep Quality Index (Buysse et al., 1989) and the Epworth
Sleepiness Scale (Johns, 1991), it was found that Jane sleeps poorly and has a significant amount
of daytime sleepiness, respectively. Aside from the assessments done, which indicate a need for
further medical evaluation to assist in proper sleeping maintenance, it has been noted by Jane’s
neighbor that she sleeps for most of the day off and on, as every time her neighbor walks up to
the door she is napping. It has also been stated that “the transition from adulthood to middle and
old age is characterized by a shift to earlier sleep-wake schedules, poor sleep consolidation,
reduced total sleep time, disorganized circadian rhythms, and decreased circadian amplitude…
all factors that are also often affected by mood disorders” (Robillard et al., 2014). Sleep is Jane’s
IMPACT OF AGING ON THE ELDERLY 9
priority problem area, as sleep disorders are linked to a lot of other health problems that can
develop from lack of sleep. One problem that sleep deficiency is linked to is mood disorders,
As cited in the study done by Robillard et al. in 2014, “decreased energy levels, apathy,
and daytime fatigue are hallmark features of depressive syndromes and are likely to result from,
and be further exacerbated by, sleep-wake disturbances”. Jane expresses all of these symptoms
on a regular basis, and also has difficulty sleeping at night. Her lack of sleep can be contributing
Jane has been clinically diagnosed with depression, and is on medication for it, however
this is still a large problem area in her life. Upon assessment, Jane’s Geriatric Depression Scale
(Yesavage et al., 1982) score was a little high, indicating that she may have mild depression that
is not being fully treated. Coupled with her subjective symptoms of crying often and feeling
extremely lonely, Jane still has a significant problem with her depression. According to a study
done in 2014, Lin et al. stated that it has been shown that “stroke, loss of hearing, poor eyesight,
cardiac disease, and chronic lung disease were factors associated with depression in old age”.
Jane has a history of chronic lung disease- emphysema, and also a mild to moderate loss of
hearing. These can be contributing to her depression, along with sleep deprivation. These
unresolved “depressive symptoms had higher rates of clinic visitation and re-hospitalization”
(Lin et al., 2014). This is a major problem for Jane, especially since she already does not like to
Nursing Diagnoses
Four pertinent nursing diagnoses were laid out for Jane, in respect to two of her major
problem areas, which were described as being sleep deprivation and depression.
IMPACT OF AGING ON THE ELDERLY 10
The first priority nursing diagnoses in relation to Jane’s sleep problem area is as follows:
sleep deprivation related to age-related sleep shifts as evidenced by difficulty falling and
remaining asleep, dozing off during the day, and fatigue. Goals for this client are to verbalize
understanding of sleep disorder by end of care, report improvement in sleep and rest pattern, and
A number of interventions can be used in order to help improve sleep deprivation. The
first priority is to assess the client’s age and developmental stage, as the need for sleep varies
widely among individuals and age groups (Alhola & Kantola, 2007). Sleep structures also
change with aging, as slow wave and sleep efficiency decrease, and alterations in the circadian
rhythm occur, and sleep complaints also become more frequent (as cited in Alhola & Kantola,
2007). The second priority intervention is the the implementation of effective age-appropriate
bedtime rituals. Sleep stimulus control therapy eliminates behaviors in the bedroom that can
exacerbate sleep deprivation, including techniques such as making sure the bedroom is restful
and comfortable, going to bed only if you feel sleepy, and avoiding sleep-fragmenting substances
such as caffeine, nicotine, and alcohol (Am, 2009). These two interventions will assist in
The second priority diagnosis for Jane is readiness for enhanced sleep related to
expression of desire to enhance sleep as evidenced by the patient stating “I would really like to
be able to sleep better at night rather than napping during the day” (J. Doe, personal
communication, February 8, 2017). Goals for Jane are to identify individually appropriate
interventions to promote sleep at night and verbalize feeling rested after sleep.
IMPACT OF AGING ON THE ELDERLY 11
The first priority intervention is to review with Jane her usual bedtime rituals, routines,
and sleep environment needs, along with her sleep in general. This will provide information on
Jane’s management of the situation and will also identify areas that might be modified when the
need arises, as this is the best method for “detecting sleep-wake problems in ambulatory older
people, to simply inquire about sleep on a regular basis” (Am, 2009). Furthermore, “the patient’s
responses should indicate how to proceed with any further history, focused physical examination,
or laboratory interventions” (Am, 2009). This is the first priority because it is so essential in
finding how to proceed with any potential problems. The second priority intervention would be
to initiate the use of relaxation therapy. Relaxation therapy is used because it “guides individuals
to a calm steady state when they wish to go to sleep” (Am, 2009). This is useful because it helps
promote sleep in the elderly individual on their own terms. Lastly, the third priority intervention
measures to help sleep, such as a warm bath, light protein snack before bedtime, and comfortable
room temperature. The rationale for this is that non-pharmacological aide can enhance sleep
without the undesired side effects of medications (Doenges, Moorhouse, & Murr, 2016).
The first priority diagnoses for Jane when related to her depression is impaired social
interaction related to fear of death of friends as evidenced by verbalized discomfort with making
new friends as client believes they will die. Goals for Jane are identifying feelings that lead to
poor interactions, and resumption of sustaining relationships with friends and family members in
one month.
The primary intervention for Jane is to determine the use of coping skills and defense
mechanisms, as the use of active solitude, social contact, sad passivity, and increased activity
IMPACT OF AGING ON THE ELDERLY 12
distancing and denial are defense mechanisms commonly used by the depressed elderly (Raut et
al., 2014). This can become an obstacle for creating friendships and other relationships, and
further cause impaired social interaction. The secondary intervention for Jane is to seek
community programs for client involvement that promote positive behaviors that Jane is striving
to achieve, as this can minimize feelings of isolation, which can increase feelings of self-worth
The secondary diagnosis for Jane is disturbed thought processes related to depressed
mood as evidenced by high geriatric depression score scale score and verbalization of depressed
feelings such as crying and sadness. Goals for Jane are to discuss irrational thoughts about self
and other by the end of the first day, discuss medication treatment for depression with physician.
The primary intervention for Jane is to help her identify negative thinking and thoughts,
as these thoughts add to feelings of hopelessness and loneliness and contribute to a negative
thought process (Raut et al., 2014). The secondary intervention for Jane is to discuss
pharmacological intervention with her health care provider. The rationale for this is that “the
of side-effects, and adequate duration of treatment will improve outcomes for older persons
(Frank, 2014). These interventions will help to improve Jane’s depression from more than one
approach, which will allow her to correct her disturbed thought processes.
Conclusion
Jane’s major problem areas of sleep disorders and depression can be fixed using the
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