Geriatric Nursing: Essential Considerations for Elderly Care

Age-Related Changes

Cardiovascular

• Decreased cardiac output, increased peripheral resistance
• Orthostatic hypotension risk increases
• Heart valves may calcify

Respiratory

• Decreased lung elasticity and vital capacity
• Reduced cough reflex
• Increased risk for pneumonia

Musculoskeletal

• Decreased bone density (osteoporosis risk)
• Reduced muscle mass (sarcopenia)
• Joint stiffness and decreased ROM

Neurological

• Slower reaction times
• Decreased sensory perception
• Sleep pattern changes

Polypharmacy Management

Elders take an average of 5+ medications, increasing risks for:

• Drug-drug interactions
• Adverse drug reactions
• Medication non-adherence
• Falls

Beers Criteria

Medications to avoid or use with caution in older adults:

• Benzodiazepines (fall risk)
• Anticholinergics (confusion)
• NSAIDs (GI bleeding, renal impairment)
• First-generation antihistamines (sedation)

Nursing Responsibilities

• Medication reconciliation at every visit
• Assess for adverse effects
• Simplify medication regimens when possible
• Use pill organizers and reminders
• Educate on each medication's purpose

Fall Prevention

Risk Assessment

Use validated tools: Morse Fall Scale, Hendrich II

Interventions

• Environmental modifications (lighting, remove rugs, grab bars)
• Non-slip footwear
• Assistive devices properly fitted
• Medication review (reduce sedating meds)
• Exercise programs for strength and balance
• Regular vision and hearing checks

Cognitive Assessment

Mini-Mental State Examination (MMSE)

30-point questionnaire testing orientation, memory, attention, language.

Montreal Cognitive Assessment (MoCA)

More sensitive for mild cognitive impairment.

Confusion Assessment Method (CAM)

Specifically designed to detect delirium:

1. Acute onset and fluctuating course
2. Inattention
3. Disorganized thinking
4. Altered level of consciousness

Delirium vs. Dementia vs. Depression

• Delirium: Acute onset, fluctuating, reversible, medical cause
• Dementia: Gradual onset, progressive, irreversible, cognitive decline
• Depression: Variable onset, treatable, affects mood primarily

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