Old age comes for us all, and with age comes the increased likelihood of one or more chronic conditions. While many of these conditions are, unfortunately, incurable, they can often be managed, allowing sufferers to continue living worthwhile, independent lives as senior citizens. Quality nursing care is essential for elderly people living with chronic conditions and nurses use a range of methods and techniques to ensure this care is appropriate, effective, and tailored to the needs of the individual.
With people living longer and the ‘baby boomer’ generation reaching retirement age, the US has a rapidly aging population. The demand for family nurse practitioners and geriatric nurses who are trained to care for elderly patients has never been greater. Indeed, the country faces a worrying shortfall of qualified nurses unless drastic steps are taken to ensure greater numbers of new nurses and advanced nurse practitioners join the workforce over the following years.
For working nurses, there has never been a better time to complete an online DNP FNP program to become a fully qualified Doctor of Nursing Family Practitioner. Walsh University Online enables prospective nurses to earn a DNP-FNP and MSN credential at the same time in as little as three years, with a series of eight and 16-week courses designed to fit in around a busy schedule. Students learn to prioritize patient needs, develop advanced clinical and leadership skills, and leave ready to provide evidence-based care tailored to unique populations and cultures.
Chronic conditions
Some common chronic conditions that affect the elderly are dementia (including Alzheimer’s and Parkinson’s disease), arthritis, osteoporosis, cancer, heart disease, diabetes, kidney disease, and chronic obstructive pulmonary disease (typically either bronchitis or emphysema). Although some conditions, from high blood pressure to multiple sclerosis, can affect people at any age, all these conditions are found more often in individuals in late middle age or older.
In short, the longer a person lives, the more likely it is that at least one chronic condition will manifest. In some cases, this can be the result of poor diet, lack of exercise, unhealthy habits like smoking, or unsanitary working and living conditions over the course of a lifetime. But even the healthiest person can develop one or more chronic conditions eventually, with hereditary and other complex factors also at play. However, leading a healthy lifestyle when younger certainly improves the chances of avoiding the worst symptoms of these conditions for as long as possible.
Challenges with older patients
Caring for the elderly, whether in hospitals, nursing homes, community clinics, or in the patient’s own home, presents a specific set of challenges and unique factors. One of these is comorbidity, where a patient may be suffering from multiple conditions. In these circumstances, it can be difficult to correctly attribute symptoms to a particular condition, which in turn can lead to problems prescribing the appropriate treatment.
A similar problem is presented by polypharmacy, where an older patient may already be taking a range of different drugs or medications. Understanding how these drugs interact with each other and what the possible side effects can be, especially with a particular combination of drugs, is essential when evaluating symptoms or considering further prescriptions.
Effective communication
The elderly are more likely to have impaired hearing, sight, or cognitive functions. This can make communication more difficult between patients and nurses. The patient may have problems in making themselves understood, or in understanding what is being said to them. Often, they are as mentally acute as ever, but struggle to hear, read, or speak, and so are assumed to be less capable than they are. In other cases, memory loss, confusion, disassociation, or other cognitive issues may mean they struggle to process and retain information.
Nurses need to be patient and to take steps to identify and overcome the barriers to communication. This may simply mean speaking slowly and clearly while in the patient’s direct line of sight or speaking louder without shouting or yelling. It may mean changing the way information is delivered, for instance writing information down rather than delivering it verbally.
Elderly patients with communication issues may initially present as surly or unresponsive. However, this may just be the result of frustration and isolation. Being prepared to work with older people, gain their trust, and help them to overcome these problems can be extremely rewarding as well as beneficial for the patient’s overall health prospects.
Mental health
Aging can often be accompanied by debilitating mental health conditions such as depression and anxiety. A loss of independence, inability to continue doing the things they enjoy, and increasing social isolation can all lead to sadness, apathy, and even a sense that life isn’t worth living. In some cases, professional counseling, or medication (antidepressants) may be required to counter this. But compassionate care, including encouragement to exercise, eat regular healthy meals, and continue to be active as much as possible, can also go a long way to combating age-related depression.
If left untreated, depression can lead to a lack of self-care as well as low energy, trouble sleeping, and ultimately greater susceptibility to other illnesses or conditions. Showing respect and kindness when talking about end-of-life issues, and when helping with personal hygiene or other intimate functions, is essential in making sure older patients don’t feel devalued or dehumanized.
Most common conditions for the elderly
The most common chronic condition among older people in the US is hypertension, or high blood pressure. This is followed by high cholesterol, and the two conditions are often found together. The third most common chronic condition is arthritis, followed by coronary heart disease, diabetes, and chronic kidney disease. Heart failure, depression, dementia, and chronic obstructive pulmonary disease complete the top ten.
It is estimated that 80% of adults aged 65 and over have at least one chronic condition, and 68% have two or more. A large part of nursing care for older patients is providing information on their condition and guidance on how to manage it. Below are quick summaries of some of the leading chronic conditions affecting the elderly.
Hypertension
Hypertension occurs when the heart is pumping plenty of blood but narrowed arteries resist the flow. If untreated, this can lead to a stroke or heart attack. The narrowing of the arteries is often caused by high cholesterol, meaning that the heart must pump harder to get blood through them, putting it under unnecessary and sometimes unsupportable strain.
Ischemic or coronary heart disease can result from this narrowing of the arteries, with blood clots, angina, and heart attacks as symptoms. To avoid hypertension in later life, eat a healthy diet and maintain a healthy weight through regular exercise. Keep your intake of salt, alcohol, and saturated fats low, and avoid smoking. Stress can raise your blood pressure, so try to manage this through better lifestyle choices and practices like mindfulness and meditation.
Arthritis
There are two types of arthritis, the most common being osteoarthritis which is caused by normal wear and tear as a person gets older. The second type is rheumatoid arthritis, which is an autoimmune disease where the lining around the joints is attacked by the body’s immune system. Unfortunately, there is no known cure for arthritis, but it can be managed using painkillers, corticosteroids, pain management, and physical therapy.
Symptoms of arthritis include pain, stiffness, and trouble moving. The joints may feel tender or inflamed. Arthritis can become progressively worse and is often affected by cold or damp weather. While the climate doesn’t cause the condition, sufferers sometimes move to warmer and less humid environments in an effort to feel more comfortable.
Diabetes
While diabetes can develop at any age, it is more common in middle-aged and older adults, with the risk increasing significantly after the age of 45. A healthy diet and exercise to maintain a healthy weight can help people avoid this, but once a person has become diabetic, they are stuck with it, and it must be managed as a lifelong condition.
Diabetes is a condition where the body isn’t producing enough insulin for it to function normally. Insulin is the hormone that allows the body to extract energy from food. Without it, high blood sugar can lead to kidney disease and even blindness. Diabetics need to take insulin regularly in the form of medication and can usually lead normal, independent lifestyles so long as they don’t miss their injections.
Chronic kidney disease
Diabetes is one of the main causes of kidney disease, alongside high blood pressure, infection, and inflammation. Unfortunately, the condition is incurable, and initial symptoms are hard to spot, but eventually it can lead to complete kidney failure as the kidneys simply cease to function over time.
Signs to look out for include nausea, tiredness, and shortness of breath. Blood in the urine or swelling in the hands, feet, or ankles, are other symptoms that could indicate kidney disease.
Dementia
Dementia is an umbrella term for a range of chronic conditions that affect memory or cause cognitive impairment. Common forms of dementia include vascular dementia, Alzheimer’s disease, and Parkinson’s disease. Dementia is often caused by damage to the brain cells or a loss of connection between the cells that causes them to die off.
There are a large number of symptoms relating to dementia, including memory loss, difficulties with cognitive reasoning, critical thinking, problem solving and verbal expression, declining motor functions and coordination, and general confusion or disorientation.
Patients suffering from dementia may become depressed, withdrawn, anxious, paranoid, or agitated. They may also suffer from hallucinations and seem to undergo a personality change, sometimes behaving in an out-of-character or inappropriate way. For this reason, dementia can be distressing for friends and relatives, and requires careful nursing care.
Chronic obstructive pulmonary disease
Chronic obstructive pulmonary disease (COPD) covers several conditions, including bronchitis and emphysema. An infection causes mucus to build up in the lungs, which the body tries to shift with coughing. As with many chronic conditions, genetic and hereditary factors play a part, but the biggest contributing cause is smoking. People may also develop COPD due to environmental reasons, such as breathing in dust or chemical fumes at work or at home.
Individuals with COPD are more susceptible to respiratory infections and illnesses like flu, pneumonia, or COVID-19. Symptoms include shortness of breath, coughing, chest, head, and throat pain, extreme tiredness, and congestion.
Individual centered care
Nurses can help individuals to manage their conditions through information, advice, and support. Encouraging the elderly to participate in their own care is one of the most important services a nurse can provide. While some people may need round the clock care in an institution, others may be able to lead relatively independent lives, provided they are given the support and assistance they need.
Not everyone wants to take an active role in managing their condition, however, and nurses may find it helpful to draw up a written agreement at the start of the care process. This outlines the level of commitment that both parties are prepared to give, sets boundaries, and outlines the obligations and responsibilities of both patient and caregivers. This document may also be a legal requirement to protect nurses from potential future litigation.
Maximum benefit
Self-management requires patients to accept that they have a chronic condition and to integrate it into their lives. While nurses always aim to help patients live as normal a life as possible, often they need the patient to accept that the condition requires some significant and permanent changes to their lifestyles. Sometimes, patients are reluctant to take this step.
Nurses can provide guidance and recommendations tailored to the patient’s needs and social environment, so that changes can be minimal and confer maximum benefit in terms of managing the condition. This support role, where the nurse is the primary point of contact within the healthcare system, can be as helpful as physical care for a patient.
Most older people suffer from at least one chronic condition, but many still lead satisfying, independent lives. Compassionate, patient-focused nursing is all about helping people to manage their conditions and to make their own choices, individually or in agreement with their family, to continue with a healthy lifestyle.
