Fundamentals · chapter 41 · Older Adults
The Nurse’s Role in Preventing Illness
The 13 things this section of the textbook says that you are most likely to be asked about — quoted word for word, not retold. Then 5 practice questions with the reasoning.
Key points
Prevention and promotion role
Nurses are key to illness prevention and health promotion for older adults. Coordination of care is crucial for minimizing the health consequences of disease and ensuring that appropriate health screenings are completed on time.
Injury and fall prevention
Nurses can help prevent injuries and falls with diligent safety awareness. By using screening tools for functional health and mental health disorders, nurses can ensure patients have the support tools they need to maintain a good quality of life throughout older adulthood.
Individualized older adult care
Nurses are critical in ensuring that older adults receive individualized care, including ancillary therapies (additional or supplementary therapeutic interventions that are used alongside primary or main forms of treatment), specialty medical evaluations, nutritional support, and screening tests.
Referral assessment responsibilities
Nurses are often responsible for assessing functional health, nutritional status, and gaps in care requiring referrals.
Functional health assessment purpose
By assessing functional health, nurses create a springboard for various treatment modalities to help older adults maintain their maximum quality of life.
Comprehensive geriatric assessment elements
A CGA evaluates ADLs, IADLs (activities that allow an individual to live independently in a community, such as cooking, cleaning, and managing medications), mental health, fall risk, pain, polypharmacy (simultaneous use of multiple medications), nutrition, sensory issues, dentition, and advanced care preferences.
Health screening planning
Awareness of age-appropriate health screening is essential for creating a comprehensive nursing care plan that promotes disease prevention.
Pain management complexity
Pain management in older adults can be complex due to various factors that contribute to the challenges of assessment and treatment.
Cognition and pain assessment
One significant factor is cognition, as many older individuals may experience cognitive decline, including conditions like dementia or Alzheimer disease. This decline can impede effective communication about pain symptoms, making it difficult for healthcare providers to accurately assess and address pain levels.
Benefits of physical activity
Physical movement is crucial for older adult s. High- and low-intensity activity helps maintain muscle mass, improve balance, improve circulation, and minimize fat deposition.
Medication education opportunities
Medication education is vital during several key patient interactions. Nurses have opportunities to explain medication treatments during admission assessments, medication administration, discharge planning, patient education sessions, outpatient clinics, follow-up visits, and home health visits, ensuring patients understand the purpose, potential side effects, and proper administration of their medications.
Polypharmacy safety risk
With each addition of medication, the risk for drug-drug interactions significantly increases. There is a risk for compounded side effects and a risk to organs such as the kidney and liver.
Abuse and neglect screening
Nurses must always remain diligent in monitoring for signs of abuse and neglect in older adult populations. This is especially true for individuals with dementia, those who live alone, and those with financial strain.
Terms to know
- ancillary therapies
- Nurses are critical in ensuring that older adults receive individualized care, including ancillary therapies (additional or supplementary therapeutic interventions that are used alongside primary or main forms of treatment), specialty medical evaluations, nutritional support, and screening tests.
- geriatric nursing
- While nurses working in most settings will care for older adults, it is important to note there is a specialized branch of nursing, geriatric nursing, dedicated to the comprehensive care of older adults.
- functional health
- An individual’s ability to complete necessary daily tasks is called functional health.
- comprehensive geriatric assessment (CGA)
- A comprehensive geriatric assessment (CGA) is a detailed assessment that includes many health indexes.
- polypharmacy
- Polypharmacy refers to using multiple medications simultaneously to treat one or more medical disorders.
Practice questions
Stuck on select-all-that-apply? How to take them one option at a time.
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Every question here, with the answer
An older adult tells the nurse, “I can bathe and dress myself, but I am having trouble preparing meals, managing my medications, paying bills, and arranging transportation.” Which assessment tool is most appropriate for the nurse to use next?
- Instrumental activities of daily living assessment
- Geriatric Depression Scale
- Wong-Baker FACES Pain Rating Scale
- Activities of daily living assessment
Answer: Instrumental activities of daily living assessment
Instrumental activities of daily living assess more complex tasks needed to live independently in the community, such as meal preparation, medication management, finances, and transportation. ADLs focus on basic self-care tasks, the GDS screens for depression, and the Wong-Baker scale is used for pain assessment.
A nurse is caring for an 85-year-old postoperative patient who is confused, has difficulty sleeping, is slow to resume mobility, and is at risk for another fall. Which patient risks should the nurse monitor using the SPICES tool? Select all that apply.
- Advanced care preferences
- Evidence of falls
- Sleep disorders
- Confusion
- Incontinence
Answer: Evidence of falls, Sleep disorders, Confusion, Incontinence
SPICES helps nurses maintain awareness of common complication risks in older adults, including sleep disorders, incontinence, confusion, and evidence of falls. Advanced care preferences are included in a comprehensive geriatric assessment, not the SPICES tool.
An older adult with cognitive decline is receiving pain medication after a procedure but has difficulty describing pain. Which nursing action best supports safe pain management?
- Use facial expressions and other discomfort indicators before and after medication administration
- Focus only on sleep quality to determine whether pain is controlled
- Avoid pain assessment because cognitive decline makes it unreliable
- Assess pain only when the patient verbally requests medication
Answer: Use facial expressions and other discomfort indicators before and after medication administration
The section recommends observing facial expressions and other indicators of discomfort, especially when patients have difficulty describing pain. Assessing before and after medication helps evaluate the effect of the intervention, while the other options omit or narrow the assessment inappropriately.
During discharge teaching, the nurse reviews an older adult’s medication list and identifies several medications, including one flagged by the AGS Beers Criteria. Which nursing actions are appropriate? Select all that apply.
- Communicate with pharmacists and prescribers about safer alternatives
- Explain potential risks and involve the patient in decisions about care
- Review the patient’s prescription and over-the-counter medication history
- Tell the patient to stop the flagged medication immediately without contacting the prescriber
- Document medications flagged by the Beers list
Answer: Communicate with pharmacists and prescribers about safer alternatives, Explain potential risks and involve the patient in decisions about care, Review the patient’s prescription and over-the-counter medication history, Document medications flagged by the Beers list
The nurse’s role includes assessing medication history, documenting Beers-listed medications, communicating with the healthcare team, and educating the patient about risks. The nurse should not independently tell the patient to stop a medication without appropriate provider collaboration.
A nurse is helping plan preventive care for an older adult and wants to ensure appropriate health screenings are discussed with the provider. Which items may be included in screening test standards for older adults? Select all that apply.
- Mammograms
- Colon cancer screening
- Osteoporosis screening
- Routine sleep aid prescriptions for all older adults
- Fall risk evaluation
Answer: Mammograms, Colon cancer screening, Osteoporosis screening, Fall risk evaluation
The section lists colon cancer screening, mammograms, osteoporosis screening, and fall risk evaluation among screening test standards for older adults. Routine sleep aid prescriptions are not listed as a screening standard and should not be generalized to all older adults.
Where every quote comes from
Section 41.4 The Nurse’s Role in Preventing Illness of Fundamentals of Nursing by Christy Bowen, Lindsay Draper, Heather Moore, OpenStax, 2024. Read the whole section free at openstax.org.
The textbook is licensed under CC BY-NC-SA 4.0. This page quotes it word for word and adds the headings, the order and the practice questions; references to the book's figures and stray spaces left by its formatting are removed. The page is shared under the same licence. Nothing here is sold.