Page 96 nursing.elitecme.com Complete Your CE Test Online - Click Here Immunodeficiency disorders Mr. St. John is a 75-year-old retired construction worker who is infected with the human immunodeficiency virus (HIV). His infection was traced to a blood transfusion Mr. St. John received many years ago. He has difficulty dealing with the disorder and says he is “ashamed.” He is doing well on his treatment regimen and his wife of 50 years is supportive. But Mr. St. John needs help dealing not only with the physical components of HIV infection, but in dealing with its emotional consequences as well. Infection with HIV is often underreported and under-diagnosed in the older adult population. Although the average age of patients who are first identified as HIV positive is progressively increasing, both older adult and some healthcare workers seem to lack knowledge about the potential for HIV infection in the older adult population. Older persons who have had multiple sexual partners in their youth may continue to have multiple partners as they age. Unfortunately, many older adults have unprotected sex, because the risk of pregnancy is no longer an issue among older couples [9,13]. The rates of sexually transmitted diseases or infections are increasing among persons who live in retirement or over-55 communities. This also includes an increase in the incidence of HIV infection in this population [9]. When HIV was first recognized as a serious health problem, the primary means of transmission of the virus in older adults was via blood transfusion. But today, the risk of infection for older adults seems to be primarily due to intravenous drug use and sexual activities. As a result of the increasing incidence of HIV infection, the CDC recommends that routine HIV testing should be initiated in all healthcare settings for persons between the ages of 13 to 64. Persons over the age of 64 should be counseled to receive HIV screening if they have risk factors for the infection [9]. Nursing consideration: When assessing the health status of an older adult, nurses should provide patient education regarding sexually transmitted diseases, including HIV. Such education is often automatic when working with younger patients. Age should not preclude a nurse from offering this type of education to all patients. Vulnerability to infections in the older adult As the immune system undergoes age-related changes that reduce effectiveness, nurses need to be aware that older patients are at increased risk of infection. This risk includes viral infections such as influenza, bacterial infections such as pneumonia, and infections following surgery or other open wounds. Even a slight laceration may result in a serious infection [9,14,53]. Because of its prevalence, it is appropriate to discuss pneumonia as a problem of particular concern among older adults. The prognosis is generally good for persons with normal respiratory function and intact immune systems. However, among older adults (i.e., people over the age of 65), especially those who may have a compromised immune system or are dealing with chronic disease or disorders, pneumonia is a leading cause of death. Not only is it the most common hospital- acquired infection (nosocomial infection), but also it has the highest mortality rate of such infections [9]. To add to the problem of pneumonia among older adults, the signs and symptoms of the disease in this population are often atypical. The cardinal signs of fever, chest pain, fever, chills, and shortness of breath may be subtle and not obviously apparent. Persons over the age of 65 are urged to receive the pneumococcal vaccine [9,13]. Nursing consideration: Older adults who live alone in the community seem to be at particular risk for not being diagnosed until pneumonia has reached an advanced stage [9]. This could be because symptoms are so subtle that the patient may assume he has a cold or simple viral infection. Educate older adults to be aware of the prevalence of pneumonia and to recognize the signs and symptoms as they appear in the older population. When possible, educate family members, friends, and caregivers about signs and symptoms that indicate pneumonia. The earlier the disease is recognized, the prompter and more effective the treatment. Summary Nurses working with older adults have unique opportunities to promote health and wellness throughout a long, and hopefully productive, lifespan. Although basic assessment techniques of interview, observation, auscultation, percussion, and palpation are similar for all age groups, the unique aspects of the aging process require that the nurse have an in-depth understanding of how the body ages and a respect for older patients and their wealth of life experiences. Nurses also have unique opportunities to teach their colleagues about the older population and to dispel myths about this age group. All healthcare professionals should understand that “old” does not equate with “sick.” Most older adults live independently and enjoy their lives. Too many persons believe that older adults are inactive physically, mentally, and sexually. Nothing could be further from the truth. This age group deserves the respect and support of the healthcare profession. They also deserve the opportunity to access healthcare services provided by professionals who understand how the body ages and want to serve as advocates for older adults. Work with your older patients to not only promote their health and well-being, but to promote community awareness of the contributions older adults have made, and can continue to make, to their families, friends, and communities. References 1. United States Census Bureau (2015). Quick facts United States. Retrieved January 5, 2016 from: http://www.census.gov/quickfacts/. 2. World Health Organization (WHO) (2015). Aging and health: Key facts. Retrieved January 5, 2016 from: http://www.who.int/mediacentre/factsheets/fs404/en/#. 3. National Council on Aging (2015). Healthy aging facts. Retrieved January 16, 2016 from: https:// www.ncoa.org/news/resources-for-reporters/get-the-facts/healthy-aging-facts/. 4. Centers for Disease Control and Prevention (CDC) (2015). Chronic diseases: The leading causes of death and disability in the United States. Retrieved January 8, 2016 from: http://www.cdc.gov/ chronicdisease/overview/index.htm. 5. Miller, L. L., et al. (2010). Enhancing the capacity to teach gerontological nursing: A faculty development project. The Journal of Continuing Education in Nursing, 41(5), 211-216. 6. Clark, K. C., et al. (2015). Implementing gerontological nursing evidence-based practice guidelines in a BSN curriculum. Journal of Gerontological Nursing, 41(7), 21-28. 7. Buss, J. S., & Labus, D. (Eds.) (2010). Assessment: An incredibly visual pocket guide. Philadelphia, PA: Wolters Kluwer Health/Lippincott Williams & Wilkins. 8. Catalyst (2014). People of color in the United States. Retrieved January 9, 2016 from: http://www. catalyst.org/knowledge/women-color-united-states-0. 9. Tabloski, P. A. (2013). Gerontological nursing (3rd ed.). Upper Saddle River, NJ: Prentice Hall. 10. Nettina, S. (2014). Lippincott manual of nursing practice (10th ed.). Philadelphia, PA: Wolters Kluwer Health/Lippincott Williams & Wilkins. 11. Galanti, G. A. (2015). Cultural diversity in healthcare. Retrieved January 13, 2016 from: http://www. gagalanti.com/cultural_profiles.html. 12. Benjamin, T. (2012-2015). Generational characteristics of the workplace. Retrieved January 13, 2016 from: http://smallbusiness.chron.com/generational-characteristics-workplace-14524.html. 13. Durkin, M. T. (Ed.) (2013). Professional guide to diseases (10th ed.). Philadelphia, PA: Wolters Kluwer Health/Lippincott Williams & Wilkins. 14. Bartelmo, J. M. (Clinical Ed.) (2013). Assessment made incredibly easy (5th ed.). Philadelphia, PA: Wolters Kluwer Health/Lippincott Williams & Wilkins. 15. Rughwani, N. (2011). Normal anatomic and physiologic changes with aging and related disease outcomes: A refresher. Mount Sinai Journal of Medicine, 78, 509–514. 16. Mayo Clinic (2013). Leukoplakia. Retrieved January 10, 2016 from: http://www.mayoclinic.org/ diseases-conditions/leukoplakia/basics/definition/con-20023802. 17. Comerford, K. C. (Ed.). (2016). Nursing 2016 nursing drug handbook. Philadelphia, PA: Wolters Kluwer. 18. United States Department of Agriculture (2015). Choose MyPlate.gov. Retrieved January 10, 2016 from: http://www.choosemyplate.gov/older-adults#. 19. Skidmore-Roth, L. (2010). Mosby’s handbook of herbs & natural supplements (4th ed.). St. Louis, MO: Mosby Elsevier. 20. American Geriatric Society (2015). American Geriatrics Society 2015 updated Beers Criteria for potentially inappropriate medication use in older adults. Journal of the American Geriatric Society, 63, 2227–2246. 21. Wallace, M. A. (2008). Assessment of sexual health in older adults. American Journal of Nursing, 108(7), 52-60. 22. Trompeter, S. E., Bettencourt, R., and Barrett-Connor, E. (2012). Sexual activity and satisfaction in healthy community-dwelling older women. American Journal of Medicine, 12591), 37-43. 23. Jena, A. B., et al. (2010). Sexually transmitted diseases among users of erectile dysfunction drugs: Analysis of claims data. Annals of Internal Medicine,153(1),1-7. 24. Brown PS. Intimacy, sexuality, and aging. (2011). In: JW Lange. The Nurse’s Role in Promoting Optimal Health of Older Adults: Thriving in the Wisdom Years. Philadelphia, PA: F. A. Davis & Company. 25. Bates, J. (2011). Broaching sexual health issues with patients. Nursing Times, 107(48), 20-22. 26. Imparato, T. and Sanders, D. (2012). STD prevalence demands clinical awareness. Aging Well, 5(10),14. Retrieved March 5, 2016 from: http://www.todaysgeriatricmedicine.com/ archive/012312p14.shtml. 27. Levtak, S., and Schoder, D. (1996). Sexually transmitted disease in the elderly: What you need to know. Geriatric Nursing,17(4), 156-160. 28. Vitiello, M. (2009). Recent advances in understanding sleep and sleep disturbances in older adults: Growing older does not mean sleeping poorly. Current Directions in Psychological Science, 18(6), 316-320. 29. Townsend-Roccichelli, J., Sanford, J.T. and VandeWaa, E. (2010). Managing sleep disorders in the elderly. Nurse Practitioner, 35(5), 30-37. 30. American Geriatric Society Panel on Chronic Pain in Older Persons (2002). The management of persistent pain in older persons: AGS panel on persistent pain in older persons. Journal of the American Geriatrics Society, 6 (50), supplement 205-224.