nursing.elitecme.com Page 17 Complete Your CE Test Online - Click Here David staring in a puzzled fashion at his car keys. He tells his wife, “I found these in my pocket but don’t really know what to do with them.” Older adults who are healthy and have small memory lapses, such as forgetting where they put their glasses, are generally not experiencing clinically significant memory problems. However, elders who get lost in familiar circumstances or forget what familiar objects are used for are in need of further evaluation and treatment (Tabloski, 2014). Normal memory and cognitive changes in aging Subtle changes in memory occur with age. These changes may not be evident, or they may cause concern. The majority of changes in memory and cognition are not of major consequence and do not interfere with activities of daily living or quality of life (Cleveland Clinic, 2016). Nursing consideration: Higher education and positive mental health are associated with better health outcomes and successful aging (Tabloski, 2014). Normal memory and cognitive changes associated with aging include the following (Cleveland Clinic, 2016; Tabloski, 2014): ● ● Learning new information occurs at a slower rate, and there is greater need for repetition. ● ● The ability to divide attention between two tasks slows. ● ● The ability to maintain sustained attention seems to decline with age. ● ● The ability to filter out or discard irrelevant information seems to decrease with age. ● ● Mental flexibility declines somewhat with age. ● ● The speed of information processing is slowed. ● ● Simple lapses in memory occur, such as forgetting where car keys are. ● ● The speed with which problem-solving skills are used decreases. ● ● Reaction time decreases with age. Nursing consideration: The ability to acquire practical experience or wisdom continues until the end of life (Tabloski, 2014). Nurses must not “talk down” to older adults or assume that they are no longer able to learn or to live enjoyable lives. Research has shown that certain factors are associated with preserving cognitive function and delaying the onset of dementia, as well as helping compensate for normal memory lapses. Following are some of these factors (Cleveland Clinic, 2016; Tabloski, 2014): ● ● Higher education helps preserve cognition and delays the onset of dementia. ● ● Making lists and posting notes regarding appointments on calendars helps with memory lapses. ● ● A diet high in antioxidants and olive oil lowers the risk of dementia. ● ● Memory training and memory enhancement techniques are helpful tactics, such as trying to link the name of a person the older adult just met with a common object or something else that is easily remembered. ● ● Staying mentally active by engaging in such activities as board games, cards, or crossword puzzles helps enhance cognition. ● ● Positive feelings about life have been linked to enhanced cognition. ● ● Engaging in social activities helps slow cognitive decline. Nurses are in a good position to assess memory loss and to offer suggestions to older adults and their families as to how to slow age- related cognitive deficits. There are memory changes associated with disease and pathological cognitive deficits that result in behaviors that are disturbing to the older adult experiencing them and to family, friends, and caregivers. Abnormal memory and cognitive changes in aging Mild cognitive impairment Mild cognitive impairment (MCI) is characterized by significant memory problems without loss of independent functioning. Older adults with MCI are quite forgetful and struggle to remember to perform tasks, such as taking medications and paying bills, but are still able to do so without the help of another person (Cleveland Clinic, 2016; Tabloski, 2014). In addition to implementing strategies previously identified as helping delay onset of serious cognitive impairment, HCPs can suggest the following interventions (Cleveland Clinic, 2016; Tabloski, 2014): ● ● Arrange for home health services - a visiting aid to monitor medication administration or housecleaning help. ● ● Facilitate the identification of a trusted family member or friend to help monitor financial issues, including paying bills. ● ● Use a large calendar to write down reminders for appointments, paying bills, and other tasks. ● ● Use a dated pill box to facilitate safe medication administration. ● ● Help arrange for a trusted family member or friend to check on the older adult at least daily. ● ● Review a list of trusted community services that provide assistance with housework, meal preparation, and other activities of daily living. Many churches have a number of service-related programs to help older adults. Dementia Dementia is actually a syndrome with signs and symptoms caused by several acquired disorders that are progressive and life limiting. Initially, those affected lose the ability to perform activities of daily living independently. Eventually, they become dependent in all aspects of self-care and independent functioning (Tabloski, 2014). Nursing consideration: Dementia can and does affect various areas of the brain, including different levels of the cortex. This means that there is no consistent course of illness and no ability to predict its progression (Tabloski, 2014). Following are some of the forms of dementia: ● ● Alzheimer’s disease (AD): AD is the most common cause of dementia. It is responsible for nearly 80% of all cases of dementia (Tabloski, 2014). It causes memory loss, confusion, impaired judgment, disorientation, loss of language skills, and changes in personality (Durkin, 2013). ● ● Vascular dementia: This is the second most common form of dementia. It is thought to be caused by cardiovascular issues and usually has an acute onset (Tabloski, 2014). ● ● Lewy body dementia: Lewy body dementia includes Parkinson’s disease with dementia and dementia with Lewy bodies. This particular form of dementia is characterized by the presence of round structures called Lewy bodies and neuritis found in the brain (Tabloski, 2014). ● ● Frontotemporal lobe dementia: This form of dementia is characterized by personality changes and atrophy of the frontotemporal lobe of the brain and includes Pick’s disease (Tabloski, 2014). A number of behaviors are associated with dementia. These behaviors can cause significant distress for the older adult’s family, friends, and caregivers. Even HCPs can become stressed when dealing with such behaviors. The most common causes of negative behavior are physical discomfort, overstimulation, unfamiliar surroundings, complicated tasks, and frustration. The Alzheimer’s Association (2014) has developed a brochure that describes various behaviors and how to deal with them. Nursing consideration: The Alzheimer’s Association recommends a three-step approach to help identify dementia-related behaviors and their etiology (Alzheimer’s Association, 2014): 1. Identify the behavior. 2. Consider possible solutions. 3. Try different responses.