Page 18 nursing.elitecme.com Complete Your CE Test Online - Click Here Following are common behaviors and ways to deal with them. Physical or verbal aggression Aggression can occur abruptly without specific cause or in response to a situation in which the elder feels fear or frustration. The first appropriate response is to rule out pain or other discomfort as the cause. If discomfort is not the trigger of the behavior, try to identify the cause. Focus on feelings, not facts. Facts may not necessarily be part of the problem. Limit distractions and speak calmly. Try to initiate another activity, especially one that is relaxing, such as listening to soft music. Make sure that both the older adult and the caregiver are safe. If the older adult is not able to calm down, call for assistance (Alzheimer’s Association, 2014; Tabloski, 2014). Anxiety and agitation Check for pain or other forms of discomfort, such as a full bladder (Durkin, 2013: Tabloski, 2014). Listen to the older adult’s concerns, provide reassurance, decrease noise and distractions, and move the older adult to a calm environment. Involve the person in activities, especially ones that promote relaxation. A walk may be a useful outlet for pent up energy (Alzheimer’s Association, 2014). Confusion Dementia may cause the affected person to not recognize once-familiar people, places, or objects. Suggested responses include staying calm and providing a brief explanation of who someone is or where he is. Show objects, such as photographs, that help remind the older adult of persons and places. Do not take confusion or inability to recognize relatives and friends personally (Alzheimer’s Association, 2014). Repetition Repetition can involve repeating the same sentences; constantly asking the same questions; or repeating behaviors, such as walking or folding clothes. This helps the older adult feel comfortable and secure. But such behaviors can be stressful for caregivers. Strategies to cope with repetition include looking for a specific reason for the repetition, such as fear or pain; staying calm and patient; providing answers for the older adult even if this requires repeating information several times; and redirecting the behavior into an activity (Alzheimer’s Association, 2014). Suspicion Older adults affected by dementia may become suspicious of those around them – even close family members or trusted caregivers, such as nurses. Remember not to take such behavior personally. Offer simple explanations; redirect the focus to another activity; determine, if possible, if there is a reason for the suspicion (for example, abuse); and help the older adult look for items that are misplaced (Alzheimer’s Association, 2014). Wandering and getting lost Wandering and getting lost are common behaviors. Research has shown that 6 in 10 persons with AD wander at some time. They may be looking to establish a routine or attempting to go home. Make sure their environments are safe. Encourage activity and redirect focus. In health care settings, alarm systems that sound when an older adult reaches a door or window are helpful (Alzheimer’s Association, 2014). Sleep disturbances Sleep disturbances are common problems. Strategies to help older adults with dementia get adequate sleep and rest include the following (Alzheimer’s Association, 2014): ● ● Keeping the environment at a comfortable temperature. ● ● Encouraging a regular routine of going to bed at the same time each night and waking up at the same time in the morning. ● ● Establishing routine meal times. ● ● Limiting naps during the day as much as possible. ● ● Avoiding stimulants, such as food and beverages that contain caffeine and loud music before bedtime. ● ● Incorporating some type of appropriate exercise during the day. The Alzheimer’s Association is a good resource for information about dealing with the disease and ways to provide help for caregivers. There is information about local chapters as well on the national association’s website. Contact information is available at http://www.alz.org and at 1-800-272-3900. Reducing impact of chronic illness The rapidly growing number of elders in the United States is causing a higher demand for health care and social services. It is estimated that 80% of elders have at least one chronic health condition - arthritis, hypertension, diabetes, heart disease, respiratory disease - that can lead to disability (Tabloski, 2014). These are the most common causes of disability in the United States (Tabloski, 2014): ● ● Atherosclerosis. ● ● Chronic back pain. ● ● Degenerative joint disease. ● ● Diabetes mellitus. ● ● Hearing problems. ● ● Mental health problems. ● ● Respiratory disorders. ● ● Stroke. ● ● Vision problems, including blindness. Fortunately, the rate of disability and functional limitation among elders has decreased significantly since the 1980s, with about one in five older American adults reporting a chronic disability (Tabloski, 2014). Nurses have an obligation to promote health among older adults. The focus is not only on dealing with chronic conditions but also on preventing and delaying the onset of chronic conditions and reducing their progression. CDC and other government agencies have compiled information about healthy aging. It is important that nurses and other HCPs know how to promote health and reduce the impact of chronic illness in the older population. Following are examples of important wellness interventions (Alzheimer’s Association, 2014; Tabloski, 2014): ● ● Cancer screenings: Screenings for breast, cervical, vaginal, colorectal, and prostate cancers should be conducted according to the most recent guidelines. ● ● Lab work: Cholesterol screening, fasting blood glucose, and other lab work as indicated. ● ● Bone mass screening: Every two years for those at risk. ● ● Eye examination and glaucoma screening: Annually as indicated. ● ● Immunizations: Flu vaccines annually as medically appropriate; pneumonia and hepatitis B vaccinations according to medical advice. ● ● Mental health screening: This is an important part of a complete history and physical. Following are some other initiatives to promote a healthy lifestyle among older adults (Alzheimer’s Association, 2014; Tabloski, 2014): ● ● Proper diet: Adequate hydration and a nutritious diet are important. For older adults living on a fixed income, money may be an issue when it comes to purchasing healthy foods. Financial resources should be assessed and referrals made to financial assistance resources as needed. Dental health may also be an issue. Dental health is important to overall health. It is also important for proper nutritional intake. If teeth or dentures are in poor condition, the older adult may not be able to eat adequately. ● ● Exercise: Exercise is important at all stages of life. After medical clearance, older adults should be encouraged to participate in exercise appropriate for their state of physical health. ● ● Socialization: As noted throughout this education program, it is essential for older adults to maintain contact with others and avoid isolation. ● ● Self-management programs: Nonprofit associations, such as the Arthritis Foundation, offer courses on managing the effects of aging. Older adults should be given information about local programs that help them to age in a healthy fashion. Community education provided by hospitals, churches, health-related associations, and senior citizens centers are all sources that help manage the aging process. Injury prevention is essential to the health and well-being of older adults. More than a third of people over the age of 65 experience a serious fall every year. Falls are the leading cause of accidental death in