Toward Healthy Aging: Human Needs and Nursing Response

Cover
IFC
Contents in Brief
Title
Copyright
Dedication
About the Authors
Contributors and Reviewers
Preface
Contents
1 - Gerontological Nursing Across the Continuum of Care
	CARE OF OLDER ADULTS: A NURSING IMPERATIVE
		Who Will Care for an Aging Society?
	DEVELOPMENT OF GERONTOLOGICAL NURSING
		Current Initiatives
	GERONTOLOGICAL NURSING EDUCATION
	ORGANIZATIONS DEVOTED TO GERONTOLOGY RESEARCH AND PRACTICE
	RESEARCH ON AGING
		Nursing Research
	GERONTOLOGICAL NURSING ROLES
		Specialist Roles
		Generalist Roles
			Acute Care
			Community-Based and Home-Based Care
				Case management and care management roles
			Certified Nursing Facilities
	NURSING ROLES IN TRANSITIONS OF CARE ACROSS THE CONTINUUM
		Readmissions: The Revolving Door
		Using Clinical Judgment to Promote Healthy Aging: Transitional Care
			Solutions, Nursing Actions, and Outcomes
	KEY CONCEPTS
	NEXT-GENERATION NCLEX® (NGN) EXAMINATION–STYLE QUESTIONS
	CLINICAL JUDGMENT QUESTIONS AND ACTIVITIES
	RESEARCH QUESTIONS
	1.1
Appendix Recommended Baccalaureate Competencies and Curricular Guidelines for the Nursing Care of Older Adults
	REFERENCES
2 - Aging, Health, and Wellness in a Global Community
	AGING
		How Old Is Old?
	THE YEARS AHEAD
		The Supercentenarians
		The Centenarians
		Those in Between (Born 1921–46)
		The Baby Boomers
		Significant Events That Occurred During the Lives of Today’s Older Adults
	A WELLNESS-BASED MODEL
	USING CLINICAL JUDGMENT TO PROMOTE HEALTHY AGING
	KEY CONCEPTS
	Next-Generation NCLEX® (NGN) Examination–Style Questions
	CLINICAL JUDGMENT QUESTIONS AND ACTIVITIES
	RESEARCH QUESTIONS
	REFERENCES
3 - Theories of Aging
	BIOLOGICAL AGING
		Evolution and Aging
		Free Radicals
		Mitochondrial Dysfunction
			Telomeres and Aging
		Inflammation
	USING CLINICAL JUDGMENT TO PROMOTE HEALTHY AGING: BIOLOGICAL THEORIES
	PSYCHOSOCIAL THEORIES OF AGING
		Role Theory
		Activity Theory
		Continuity Theory
		Disengagement Theory
		Social Exchange Theory
		Modernization Theory
		Gerotranscendence Theory
		Socioemotional Selectivity Theory
		Selective Optimization and Compensation Theory
	USING CLINICAL JUDGMENT TO PROMOTE HEALTHY AGING: PSYCHOSOCIAL THEORIES
	KEY CONCEPTS
	CLINICAL JUDGMENT QUESTIONS AND ACTIVITIES
	RESEARCH QUESTIONS
	REFERENCES
4 - Providing Cross-Cultural Care
	CULTURE, AGING, AND HEALTH CARE
	DIVERSITY
	HEALTH INEQUITIES AND DISPARITIES
	OBSTACLES TO CROSS-CULTURAL CARING
		Ethnocentrism
		Stereotyping
	MOVING TOWARD CULTURAL PROFICIENCY
		Cultural Destructiveness
		Cultural Blindness
		Cultural Precompetence
		Cultural Competence
			Cultural Knowledge
				Definitions of terms.
				Orientation to family and self.
				Orientation to time.
				Beliefs about health, illness, treatment, and prevention.
				Eye contact.
				The use of silence.
				Spoken communication.
				Written communication.
		Cultural Proficiency
	USING CLINICAL JUDGMENT TO PROMOTE HEALTHY AGING
		L—Listen
		E—Explain
		A—Acknowledge
		R—Recommend
		N—Negotiate
	KEY CONCEPTS
	NEXT-GENERATION NCLEX® (NGN) EXAMINATION–STYLE QUESTIONS
	CLINICAL JUDGMENT QUESTIONS AND ACTIVITIES
	RESEARCH QUESTIONS
	REFERENCES
5 - Economics and Health Care in Late Life
	ECONOMICS IN LATE LIFE
		Social Security Income
		Supplemental Security Income
		Other Late Life Income
	HEALTH CARE DELIVERY
		Changes in Health Care for Older Adults
		Medicare
			Medicare Part A
			Medicare Part B
			Medicare Part C
			Alternatives to Medicare C
			Medicare Part D
		Supplemental Insurance (Medigap)
		Medicaid
		Other Health Care Delivery Services
			Indian Health Service
		Care for Veterans
			TRICARE for Life
		Long-Term Care Insurance
	KEY CONCEPTS
	CLINICAL JUDGMENT QUESTIONS AND ACTIVITIES
	RESEARCH QUESTIONS
	REFERENCES
6 - Promoting Excellence in Long-Term Care
	FUTURE PROJECTIONS
	COSTS OF LONG-TERM CARE
		Funding for Long-Term Care
			Medicaid
			Medicare
			Private Long-Term Care Insurance
			Out-of-Pocket Spending
	LONG-TERM CARE AND THE US HEALTH CARE SYSTEM
	GLOBAL APPROACHES TO LONG-TERM CARE
	SOLUTIONS, NURSING ACTIONS, AND OUTCOMES: IMPROVING LONG-TERM CARE SUPPORTS AND SERVICES
	FORMAL LONG-TERM CARE SERVICE PROVIDERS
		Community Care
			Programs of All-Inclusive Care for the Elderly (PACE)
			Adult Day Services (ADS)
			Continuing Care Retirement Communities (CCRCs)
			Residential Care/Assisted Living (RC/AL)
				Assisted living
		Certified Nursing Facilities (Nursing Homes)
			Subacute Care (Short Term)
			Chronic Care (Long Term)
			Interprofessional Team Model in Subacute and Long-Term Care
			Professional Nursing in Long-Term Care
			Nursing Assistants
			Resident Bill of Rights
	QUALITY OF CARE IN SKILLED NURSING FACILITIES
		Choosing a Quality Nursing Home
		The Culture Change Movement
	USING CLINICAL JUDGMENT TO PROMOTE HEALTHY AGING: EXCELLENCE IN LONG-TERM CARE
	KEY CONCEPTS
	Next-Generation NCLEX® (NGN) Examination–Style Questions
	CLINICAL JUDGMENT QUESTIONS AND ACTIVITIES
	RESEARCH QUESTIONS
	REFERENCES
7 - Therapeutic Communication With Older Adults
	AGEISM AND COMMUNICATION
		Elderspeak
	THERAPEUTIC COMMUNICATION WITH OLDER ADULTS
	THE LIFE STORY
		Reminiscing
		Reminiscing and Storytelling With Individuals Experiencing Cognitive Impairment
		Life Review
	COMMUNICATING WITH GROUPS OF OLDER ADULTS
		Group Structure and Special Considerations
	USING CLINICAL JUDGMENT TO PROMOTE HEALTHY AGING: THERAPEUTIC COMMUNICATION
	KEY CONCEPTS
	Next-Generation NCLEX® (NGN) Examination–Style Questions
	CLINICAL JUDGMENT QUESTIONS AND ACTIVITIES
	RESEARCH QUESTIONS
	REFERENCES
8 - Cognitive Health and Learning
	ADULT COGNITION
		Neuroplasticity
		Fluid and Crystallized Intelligence
		Memory
		Cognitive Health
	USING CLINICAL JUDGMENT TO PROMOTE HEALTHY AGING: COGNITIVE HEALTH
		Solutions, Nursing Actions, and Outcomes
	LEARNING IN LATER LIFE
		Learning Opportunities
		Information Technology and Older Adults
	USING CLINICAL JUDGMENT TO PROMOTE HEALTHY AGING: LEARNING AND INFORMATION TECHNOLOGY
		Solutions, Nursing Actions, and Outcomes
	HEALTH LITERACY
	USING CLINICAL JUDGMENT TO PROMOTE HEALTHY AGING: HEALTH LITERACY
		Solutions, Nursing Actions, and Outcomes
	KEY CONCEPTS
	NEXT-GENERATION NCLEX® (NGN) EXAMINATION–STYLE QUESTIONS
	CLINICAL JUDGMENT QUESTIONS AND ACTIVITIES
	RESEARCH QUESTIONS
	REFERENCES
9 - Recognizing and Analyzing Cues to Maximize Outcomes
	THE HEALTH HISTORY
		Review of Systems
	PHYSICAL HEALTH
		Using a Mnemonic for the Collection of Cues in Physical Assessment
			FANCAPES
				F: Fluids
				A: Aeration and circulation
				N: Nutrition
				C: Communication
				A: Activity
				P: Pain
				E: Elimination
				S: Social skills
			SPICES
	FUNCTIONAL ABILITY
		Activities of Daily Living
		Katz Index
		Barthel Index (BI)
		Functional Independence Measure
		Functional Assessment Staging Tool
		Instrumental Activities of Daily Living
			The Lawton IADL Scale
	COGNITION
		Short Portable Mental Status Questionnaire
		Mini-Mental State Examination
		Montreal Cognitive Assessment
		Clock Drawing Test
		Mini-Cog
	MOOD
		Geriatric Depression Scale
		Cornell Scale for Depression in Dementia
	COMPREHENSIVE GERIATRIC ASSESSMENT
		Resident Assessment Instrument (RAI)
		Outcome and Assessment Information Set (OASIS-D)
		The OARS Multidimensional Functional Assessment Questionnaire
	CLINICAL JUDGMENT TO PROMOTE HEALTHY AGING
	KEY CONCEPTS
	CLINICAL JUDGMENT QUESTIONS AND ACTIVITIES
	RESEARCH QUESTIONS
	REFERENCES
10 - Using Laboratory Data in Clinical Judgment
	HEMATOLOGICAL TESTING
		Red Blood Cell Count
			Hemoglobin and Hematocrit
				Iron.
					Anemia.
		White Blood Cells
			Granulocytes
				Neutrophils.
				Eosinophils and basophils.
			Agranulocytes
				Lymphocytes.
				Monocytes.
		Infection
		Platelets
	MEASURES OF INFLAMMATION
		Erythrocyte Sedimentation Rate
	VITAMINS
		B Vitamins
			Folate (B9)
			Vitamin B12
		Vitamin D
	BLOOD CHEMISTRY STUDIES
		Basic and Comprehensive Metabolic Panels
			Sodium
				Hyponatremia.
				Hypernatremia.
			Potassium
				Hypokalemia.
				Hyperkalemia.
			Glucose
				Glycosylated hemoglobin A1C.
			Albumin
	URIC ACID
	PROSTATE-SPECIFIC ANTIGEN
	LABORATORY TESTING FOR CARDIAC HEALTH
		Acute Cardiac Events
			Creatinine Kinase
			Troponin
		Monitoring Cardiovascular Risk and Health
			hs-CRP
			Homocysteine
			B-type Natriuretic Peptide
			Lipid Panels
				Cholesterol.
					High-density lipoprotein (HDL).
					Low-density lipoprotein.
				Triglycerides.
	LABORATORY TESTS OF RENAL HEALTH
		Blood Urea Nitrogen
		Creatinine
	MONITORING FOR THERAPEUTIC BLOOD LEVELS
		Anticoagulants
		Digoxin
		Thyroid Panels
	URINE STUDIES
	USING CLINICAL JUDGMENT TO PROMOTE HEALTHY AGING
	KEY CONCEPTS
	Next-Generation NCLEX® (NGN) Examination–Style Questions
	CLINICAL JUDGMENT QUESTIONS AND ACTIVITIES
	RESEARCH QUESTIONS
	REFERENCES
11 - Safe Medication Use
	PHARMACOKINETICS
		Absorption
		Distribution
		Metabolism
		Excretion
	PHARMACODYNAMICS
	ISSUES IN MEDICATION USE
		Polypharmacy
		Drug Interactions
			Drug-Herb/Supplement Interactions
			Drug-Food/Beverage Interactions
			Drug-Drug Interactions
			Drug-Disease Interactions
		Adverse Drug Reactions and Events
	PSYCHOACTIVE MEDICATIONS
		Antipsychotics
		Malignant Syndrome
		Movement Disorders
			Acute Dystonia
			Akathisia
			Parkinsonian Symptoms
			Tardive Dyskinesia
	USING CLINICAL JUDGMENT TO PROMOTE HEALTHY AGING
		Recognizing and Analysing Cues
			STOPP/START
			Beers Criteria
	SOLUTIONS AND NURSING ACTIONS: SAFE MEDICATION USE
		Education
		Medication Reminders
		Evaluating Outcomes
		Deprescribing
	KEY CONCEPTS
	CLINICAL JUDGMENT QUESTIONS AND ACTIVITIES
	RESEARCH QUESTIONS
	REFERENCES
12 - Visual Health
	VISION IMPAIRMENT
		Incidence and Prevalence
	CHANGES IN VISION WITH AGE
		Extraocular Changes
		Ocular Changes
		Intraocular Changes
		Consequences of Visual Impairment
		Prevention of Visual Impairment
	DISEASES AND DISORDERS OF THE EYE
		Cataracts
			Treatment of Cataracts
			Solutions, Nursing Actions, and Outcomes: Cataract Surgery
		Glaucoma
			Recognizing and Analyzing Cues: Glaucoma
		Diabetic Eye Disease
		Diabetic Retinopathy
			Recognizing and Analyzing Cues: Retinopathy
		Diabetic Macular Edema
		Detached Retina
		Age-Related Macular Degeneration
			Recognizing and Analyzing Cues: Macular Degeneration
			Solutions, Nursing Actions, and Outcomes: Macular Degeneration
		Dry Eye
		Charles Bonnet Syndrome
	USING CLINICAL JUDGMENT TO PROMOTE HEALTHY AGING: VISUAL HEALTH
		Solutions, Nursing Actions, and Outcomes: Visual Health
			Special Considerations in Long-Term Care Settings
			Low-Vision Optical Devices
	KEY CONCEPTS
	NEXT-GENERATION NCLEX® (NGN) EXAMINATION–STYLE QUESTIONS
	CLINICAL JUDGMENT QUESTIONS AND ACTIVITIES
	RESEARCH QUESTIONS
	REFERENCES
13 - Auditory Health
	HEARING IMPAIRMENT
		Consequences of Hearing Impairment
		Sensorineural Hearing Loss
		Conductive Hearing Loss
	INTERVENTIONS TO ENHANCE HEARING
		Hearing Aids
		Cochlear Implants
		Assistive Listening and Adaptive Devices
	USING CLINICAL JUDGMENT TO PROMOTE HEALTHY AGING: AUDITORY HEALTH
		Recognizing and Analyzing Cues: Hearing Impairment
		Solutions, Nursing Actions, and Outcomes: Hearing Impairment
	TINNITUS
		Solutions, Nursing Actions, and Outcomes: Tinnitus
	KEY CONCEPTS
	Next-Generation NCLEX® (NGN) Examination–Style Questions
	CLINICAL JUDGMENT QUESTIONS AND ACTIVITIES
	RESEARCH QUESTIONS
	REFERENCES
14 - Healthy Skin
	SKIN
		Age-Related Skin Changes
	COMMON SKIN PROBLEMS
		Xerosis
			Pruritus
		Scabies
		Purpura
		Skin Tears
		Keratoses
		Herpes Zoster
		Candidiasis (Candida albicans)
		Photo Damage of the Skin
	SKIN CANCERS
		Facts and Figures
		Basal Cell Carcinoma
		Squamous Cell Carcinoma
		Melanoma
			Incidence and Prevalence
			Risk Factors
				Indoor tanning.
		Solutions, Nursing Actions, and Outcomes: Promoting Healthy Skin
	PRESSURE INJURIES (PIs)
		Definition
		Scope of the Problem
		Cost and Regulatory Requirements
		Characteristics
		Classification
		Risk Factors
		Prevention of Pressure Injuries
		Consequences of Pressure Injuries
		Are Pressure Injuries Always Preventable?
		Skin Changes at the End of Life
	USING CLINICAL JUDGMENT TO PROMOTE HEALTHY AGING: PRESSURE INJURIES
		Recognizing and Analyzing Cues
		Solutions, Nursing Actions, and Outcomes
		Pressure Injury Evaluation
		Pressure Injury Dressings
	KEY CONCEPTS
	NEXT-GENERATION NCLEX® (NGN) EXAMINATION–STYLE QUESTIONS
	CLINICAL JUDGMENT QUESTIONS AND ACTIVITIES
	RESEARCH QUESTIONS
	REFERENCES
15 - Nutritional Health
	NUTRITIONAL HEALTH
	AGE-RELATED NUTRITIONAL REQUIREMENTS
		United States Dietary Guidelines
			MyPlate for Older Adults
		Other Dietary Recommendations
			Fats
			Protein
			Fiber
			Vitamins and Minerals
	OBESITY (OVERNUTRITION)
	MALNUTRITION (UNDERNUTRITION)
		Characteristics
		Consequences
	FACTORS AFFECTING FULFILLMENT OF NUTRITIONAL NEEDS
		Lifelong Eating Habits
		Socialization
		Socioeconomic Deprivation
		Transportation
		Chronic Diseases and Conditions
			Gastrointestinal Conditions That Affect Nutrition
				Gastroesophageal reflux disease.
					Recognizing and analyzing cues: GERD.
					Solutions, nursing actions, and outcomes: GERD.
				Diverticular disease.
					Recognizing and analyzing cues: Diverticular disease.
					Solutions, nursing actions, and outcomes: Diverticular disease.
				Dysphagia.
					Recognizing and analyzing cues: Dysphagia.
					Solutions, nursing actions, and outcomes: Dysphagia
	USING CLINICAL JUDGMENT TO PROMOTE HEALTHY AGING: NUTRITIONAL HEALTH
		Recognizing and Analyzing Cues
		Food and Nutrient Intake
		Weight and Height Considerations
		Biochemical Analysis and Measures of Visceral Protein
		Solutions, Nursing Actions, and Outcomes
			Feeding Assistance
			Approaches to Enhancing Intake in Long-Term Care
			Restrictive Diets and Caloric Supplements
			Pharmacological Therapy
			Patient Education
	KEY CONCEPTS
	Next-Generation NCLEX® (NGN) Examination–Style Questions
	CLINICAL JUDGMENT QUESTIONS AND ACTIVITIES
	RESEARCH QUESTIONS
	REFERENCES
16 - Hydration and Oral Health
	HYDRATION MANAGEMENT
	DEHYDRATION
		Risk Factors for Dehydration
	PROMOTING HEALTHY AGING: IMPLICATIONS FOR GERONTOLOGICAL NURSING: DEHYDRATION
		Recognizing and Analyzing Cues
		Solutions, Nursing Actions, and Outcomes
	ORAL HEALTH
		Xerostomia (Mouth Dryness)
			Treatment of Xerostomia
		Oral Cancer
		Oral Care
	USING CLINICAL JUDGMENT TO PROMOTE HEALTHY AGING: ORAL HEALTH
		Recognizing and Analyzing Cues
		Solutions, Nursing Actions, and Outcomes
		Oral Hygiene in Hospitals and Long-Term Care
		Other Considerations in Oral Hygiene Provision
	KEY CONCEPTS
	NEXT-GENERATION NCLEX® (NGN) EXAMINATION–STYLE QUESTIONS
	CLINICAL JUDGMENT QUESTIONS AND ACTIVITIES
	RESEARCH QUESTIONS
	REFERENCES
17 - Elimination
	URINARY INCONTINENCE
		Urinary Incontinence Facts and Figures
		Risk Factors for Urinary Incontinence
		Consequences of Urinary Incontinence
		Types of Urinary Incontinence
	USING CLINICAL JUDGMENT TO PROMOTE HEALTHY AGING: URINARY INCONTINENCE
		Recognizing and Analyzing Cues
		Solutions, Nursing Actions, and Outcomes
			Lifestyle Modifications
			Promotion of Continence-Friendly Environment
			Behavioral Techniques
				Scheduled (timed) voiding
				Pelvic floor muscle exercises
				Habit retraining
				Bladder retraining
				Prompted voiding (PV)
		Other Urinary Incontinence Management Techniques
			Absorbent Products
			Use of Intermittent Catheterization, Indwelling Catheters, and External Catheters
			Pharmacological Approaches
			Surgical Treatment and Nonsurgical Devices
			Nonsurgical Devices
	URINARY TRACT INFECTIONS (UTIs)
		Catheter-Associated Urinary Tract Infections
	BOWEL ELIMINATION
		Constipation
			Fecal Impaction
	USING CLINICAL JUDGMENT TO PROMOTE HEALTHY AGING: BOWEL FUNCTION
		Recognizing and Analyzing Cues
		Solutions, Nursing Actions, and Outcomes
			Nonpharmacological Treatment
				Physical activity
				Positioning
				Toileting regimen
			Pharmacological Treatment
				Enemas
			Alternative Treatments
	ACCIDENTAL BOWEL LEAKAGE OR FECAL INCONTINENCE
	USING CLINICAL JUDGMENT TO PROMOTE HEALTHY AGING: ACCIDENTAL BOWEL LEAKAGE (FECAL INCONTINENCE)
		Recognizing and Analyzing Cues
		Solutions, Nursing Actions, and Outcomes
	KEY CONCEPTS
	Next-Generation NCLEX® (NGN) Examination–Style Questions
	Case Study 1
	Case Study 2
	CLINICAL JUDGMENT QUESTIONS AND ACTIVITIES
	CLINICAL JUDGMENT QUESTIONS AND ACTIVITIES
	RESEARCH QUESTIONS
	REFERENCES
18 - Sleep
	BIORHYTHM AND SLEEP
	SLEEP AND AGING
	SLEEP DISORDERS
		Insomnia
		Insomnia and Neurocognitive Disorders
	USING CLINICAL JUDGMENT TO PROMOTE HEALTHY AGING: SLEEP DISORDERS
		Recognizing and Analyzing Cues
		Solutions, Nursing Actions, and Outcomes
			Nonpharmacological Treatment
				Sleep in hospitals and nursing homes.
			Pharmacological Treatment
		Sleep Disordered Breathing and Sleep Apnea
			Recognizing and Analyzing Cues
			Solutions, Nursing Actions, and Outcomes
		Restless Legs Syndrome/Willis-Ekbom Disease (RLS/WED)
			Recognizing and Analyzing Cues
			Solutions, Nursing Actions, and Outcomes
		Rapid Eye Movement Sleep Behavior Disorder (RBD)
			Solutions, Nursing Actions, and Outcomes
		Circadian Rhythm Sleep Disorders
	KEY CONCEPTS
	NEXT-GENERATION NCLEX® (NGN) EXAMINATION–STYLE QUESTIONS
	CLINICAL JUDGMENT QUESTIONS AND ACTIVITIES
	RESEARCH QUESTIONS
	REFERENCES
19 - Activity and Exercise
	PHYSICAL ACTIVITY AND AGING
	USING CLINICAL JUDGMENT TO PROMOTE HEALTHY AGING: ACTIVITY AND EXERCISE
		Solutions, Nursing Actions, and Outcomes
		Physical Activity Guidelines
		Incorporating Physical Activity Into Lifestyle
		Special Considerations
		Maintaining Function Across Care Settings
		Function-Focused Care
	KEY CONCEPTS
	Next-Generation NCLEX® (NGN) Examination–Style Questions
	CLINICAL JUDGMENT QUESTIONS AND ACTIVITIES
	RESEARCH QUESTIONS
	REFERENCES
20 - Falls and Fall Risk Reduction
	MOBILITY AND AGING
	FALLS
		Consequences of Falls
			Hip Fractures
			Traumatic Brain Injury
	FALL RISK FACTORS
		Fear of Falling (Fallophobia)
		Gait Disturbances
		Foot Deformities
		Solutions, Nursing Actions, and Outcomes
			Orthostatic and Postprandial Hypotension
			Cognitive Impairment
			Vision and Hearing
			Medications
	USING CLINICAL JUDGMENT TO PROMOTE HEALTHY AGING: FALLS AND FALL RISK REDUCTION
		Recognizing and Analyzing Cues
			Identifying Fall Risk
			Fall Screening and Assessment Guidelines in Hospitals and Nursing Facilities
		Solutions, Nursing Actions, and Outcomes
			Fall Risk Reduction in Acute and Long-Term Care
			Fall Risk Reduction in the Community
		Other Fall Risk–Reduction Actions
			Postfall Assessments
			Environmental Modifications
			Assistive Devices
			Safe Patient Handling
			Hip Protectors
			Alarms, Motion Sensors, and Staff Observation
	RESTRAINTS AND SIDE RAILS
		Definition and History
		Consequences of Restraints
		Side Rails
		Restraint-Free Care
	KEY CONCEPTS
	Next-Generation NCLEX® (NGN) Examination–Style Questions
	CLINICAL JUDGMENT QUESTIONS AND ACTIVITIES
	RESEARCH QUESTIONS
	REFERENCES
21 - Safe and Secure Environments
	ENVIRONMENTAL SAFETY
	HOME SAFETY
	CRIMES AGAINST OLDER ADULTS
		Risks and Vulnerability
		Fraudulent Schemes Against Older Adults
	FIRE SAFETY FOR OLDER ADULTS
	VULNERABILITY TO ENVIRONMENTAL TEMPERATURES
		Thermoregulation
			Temperature Monitoring in Older Adults
		Hyperthermia
		Hypothermia
		Recognizing and Analyzing Cues
		Solutions, Nursing Actions, and Outcomes
	VULNERABILITY TO NATURAL DISASTERS
	GUN SAFETY
	TRANSPORTATION SAFETY
		Driving
			Driving Safety
			Driving and Dementia
			Driving Cessation
	USING CLINICAL JUDGMENT TO PROMOTE HEALTHY AGING: DRIVING SAFETY
		Recognizing and Analyzing Cues
		Solutions, Nursing Actions, and Outcomes
	EMERGING TECHNOLOGIES TO ENHANCE SAFETY OF OLDER ADULTS
		Telehealth
		Smart Homes
		Robots
		Robopets and Therapeutic Interactive Pets
	AGING IN PLACE
		Aging in Community Models
	KEY CONCEPTS
	Next-Generation NCLEX® (NGN) Examination–Style Questions
	CLINICAL JUDGMENT QUESTIONS AND ACTIVITIES
	RESEARCH QUESTIONS
	REFERENCES
22 - Living Well With Chronic Illness
	THE CHRONIC ILLNESS TRAJECTORY
	FRAILTY
	KEY CONCEPTS
	REFERENCES
23 - Vascular Disorders
	THE AGING CARDIOVASCULAR SYSTEM
	CARDIOVASCULAR DISEASE
		Hypertension
			Recognizing and Analyzing Cues
			Pharmacological Interventions
		Coronary Heart Disease
			Recognizing and Analyzing Cues
			Pharmacological Interventions
		Atrial Fibrillation
			Recognizing and Analyzing Cues
			Pharmacological Interventions
		Heart Failure
			Recognizing and Analyzing Cues
			Pharmacological Interventions
	USING CLINICAL JUDGMENT TO PROMOTE HEALTHY AGING: CARDIOVASCULAR DISEASE
		Solutions, Nursing Actions, and Outcomes
			Healthy Eating and Optimal Weight
			Exercise and Physical Activity
			Smoking Cessation and Prevention
			Self-Care
	THE AGING PERIPHERAL VASCULAR SYSTEM
	PERIPHERAL VASCULAR DISEASE
		Recognizing and Analyzing Cues
		Pharmacological Interventions
	USING CLINICAL JUDGMENT TO PROMOTE HEALTHY AGING: PERIPHERAL VASCULAR DISEASE
		Solutions, Nursing Actions, and Outcomes
	CEREBROVASCULAR DISORDERS
		Recognizing and Analyzing Cues
		Pharmacological Interventions
	USING CLINICAL JUDGMENT TO PROMOTE HEALTHY AGING: CEREBROVASCULAR DISORDERS
		Solutions, Nursing Actions, and Outcomes
	KEY CONCEPTS
	Next-Generation NCLEX® (NGN) Examination–Style Questions
	CLINICAL JUDGMENT QUESTIONS AND ACTIVITIES
	RESEARCH QUESTIONS
	REFERENCES
24 - Respiratory Disorders
	THE AGING RESPIRATORY SYSTEM
	RESPIRATORY DISORDERS
		Chronic Obstructive Pulmonary Disease
			Recognizing and Analyzing Cues
			Pharmacological Interventions
		Asthma
			Recognizing and Analyzing Cues
			Pharmacological Interventions
		Pneumonia
			Recognizing and Analyzing Cues
	USING CLINICAL JUDGMENT TO PROMOTE HEALTHY AGING
		Solutions, Nursing Actions, and Outcomes
			Prevention
			Self-Care
			Supplemental Oxygen
			Pulmonary Rehabilitation
			Advance Care Planning
	KEY CONCEPTS
	Next-Generation NCLEX® (NGN) Examination–Style Questions
	CLINICAL JUDGMENT QUESTIONS AND ACTIVITIES
	RESEARCH QUESTIONS
	REFERENCES
25 - Neurocognitive Disorders
	ALZHEIMER’S DISEASE
		Recognizing and Analyzing Cues
		Pharmacological Interventions
	DEMENTIA WITH LEWY BODIES
		Recognizing and Analyzing Cues
		Pharmacological Interventions
	PARKINSON’S DISEASE
		Recognizing and Analyzing Cues
		Pharmacological Interventions
	USING CLINICAL JUDGMENTS TO PROMOTE HEALTHY AGING
		Solutions, Nursing Actions, and Outcomes
	KEY CONCEPTS
	Next-Generation NCLEX® (NGN) Examination–Style Questions
	CLINICAL JUDGMENT QUESTIONS AND ACTIVITIES
	RESEARCH QUESTIONS
	REFERENCES
26 - Care of Individuals With Neurocognitive Disorders
	CARING FOR INDIVIDUALS WITH NEUROCOGNITIVE DISORDERS
		Person- and Family-Centered Care
	NEUROCOGNITIVE DISORDER: DELIRIUM
		Differences Between Delirium, Dementia (Mild and Major Neurocognitive Disorder), and Depression
		Etiology
		Incidence and Prevalence
			Delirium Superimposed on Dementia (DSD)
		Recognition of Delirium
			Precipitating Factors for Delirium
		Clinical Subtypes of Delirium
		Consequences of Delirium
	USING CLINICAL JUDGMENT TO PROMOTE HEALTHY AGING: DELIRIUM PREVENTION AND TREATMENT
		Recognizing and Analyzing Cues
		Solutions, Nursing Actions, and Outcomes
			Nonpharmacological Approaches
			Pharmacological Approaches
	CARE OF INDIVIDUALS WITH NEUROCOGNITIVE DISORDERS
		Models of Care for Individuals With NCDs
		Differing Needs in Younger-Onset Dementia and Mild Neurocognitive Disorder
		End-of-Life Discussions
	CARE CONCERNS FOR PATIENTS, FAMILIES, AND STAFF CARING FOR INDIVIDUALS WITH MAJOR NEUROCOGNITIVE DISORDERS
	COMMUNICATION
		Research-Based Strategies for Communicating With Individuals With Neurocognitive Disorders
	BEHAVIOR CONCERNS AND NURSING MODELS OF CARE
		Progressively Lowered Stress Threshold Model
		Need-Driven Dementia-Compromised Behavior Model
	USING CLINICAL JUDGMENT TO PROMOTE HEALTHY AGING: BEHAVIORAL AND PSYCHOLOGICAL SYMPTOMS OF DEMENTIA
		Recognizing and Analyzing Cues
		Solutions, Nursing Actions, and Outcomes
			Pharmacological Approaches
			Nonpharmacological Approaches
	PROVIDING CARE FOR ACTIVITIES OF DAILY LIVING
		Bathing
	USING CLINICAL JUDGMENT TO PROMOTE HEALTHY AGING: BATHING COMFORT
		Solutions, Nursing Actions, and Outcomes
	WANDERING
	USING CLINICAL JUDGMENT TO PROMOTE HEALTHY AGING: WANDERING BEHAVIOR
		Recognizing and Analyzing Cues
		Solutions, Nursing Actions, and Outcomes
	NUTRITION
	USING CLINICAL JUDGMENT TO PROMOTE HEALTHY AGING: NUTRITION
		Solutions, Nursing Actions, and Outcomes
	TUBE FEEDING IN END-STAGE DEMENTIA
	NURSING ROLES IN THE CARE OF PERSONS WITH NCDs
	KEY CONCEPTS
	Next-Generation NCLEX® (NGN) Examination–Style Questions
	CLINICAL JUDGMENT QUESTIONS AND ACTIVITIES
	RESEARCH QUESTIONS
	REFERENCES
27 - Endocrine and Immune Disorders
	THE AGING IMMUNE SYSTEM
	THE AGING ENDOCRINE SYSTEM
	DIABETES MELLITUS
		Recognizing and Analyzing Cues
		Pharmacological Interventions
	USING CLINICAL JUDGMENT TO PROMOTE HEALTHY AGING: DIABETES
		Solutions, Nursing Actions, and Outcomes
			Nutrition
			Exercise
			Self-Care
		Implications for the Frail and Those Living in Residential Care Settings
	THYROID DISEASE
		Hypothyroidism
			Recognizing and Analyzing Cues
		Hyperthyroidism
			Recognizing and Analyzing Cues
	USING CLINICAL JUDGMENT TO PROMOTE HEALTH AGING: THYROID DISEASE
		Solutions, Nursing Actions, and Outcomes
	KEY CONCEPTS
	Next-Generation NCLEX® (NGN) Examination–Style Questions
	CLINICAL JUDGMENT QUESTIONS AND ACTIVITIES
	RESEARCH QUESTIONS
	REFERENCES
28 - Common Musculoskeletal Disorders
	THE AGING MUSCULOSKELETAL SYSTEM
		Bones
		Joints, Tendons, and Ligaments
		Muscles
	MUSCULOSKELETAL DISORDERS
		Osteoporosis
			Recognizing and Analyzing Cues
			Pharmacological Interventions
	ARTHRITIS
		Osteoarthritis
			Recognizing and Analyzing Cues
			Pharmacological Interventions
		Rheumatoid Arthritis
			Recognizing and Analyzing Cues
			Pharmacological Interventions
	GOUT
		Recognizing and Analyzing Cues
		Pharmacological Interventions
	USING CLINICAL JUDGMENT TO PROMOTE HEALTHY AGING
		Solutions, Nursing Actions, and Outcomes
			Nutrition
				Calcium
				Vitamin D
			Exercise
			Pain Relief
			Joint Protection
	KEY CONCEPTS
	Next-Generation NCLEX® (NGN) Examination–Style Questions
	CLINICAL JUDGMENT ACTIVITY
	RESEARCH QUESTIONS
	REFERENCES
29 - Pain and Comfort
	PAIN IN THE OLDER ADULT
		Pain in Older Adults With Cognitive or Communication Limitations
		Recognizing and Analyzing Cues
			Assessment
				Rating scales
				Observational instruments
	USING CLINICAL JUDGMENT TO PROMOTE HEALTHY AGING
		Solutions, Nursing Actions, and Outcomes
			Nonpharmacological Interventions
				Mind-body practices
				Heat and cold
				Exercise
				Transcutaneous electrical nerve stimulation
				Acupuncture and acupressure
				Energy and touch therapies
				Assistive devices
				Psychological therapy and self-care education
				Music
			Pharmacological Interventions
				Nonopioid analgesics
				Opioid analgesics
				Adjuvant pain medications
			Pain Clinics
		Evaluation of Effectiveness
	KEY CONCEPTS
	Next-Generation NCLEX® (NGN) Examination–Style Questions
	CLINICAL JUDGMENT QUESTIONS AND ACTIVITIES
	RESEARCH QUESTIONS
	REFERENCES
30 - Mental Health
	MENTAL HEALTH
	STRESS AND COPING IN LATE LIFE
		Stress and Stressors
		Effects of Stress
		Factors Affecting Stress
	USING CLINICAL JUDGMENT TO PROMOTE HEALTHY AGING: MENTAL HEALTH
		Recognizing and Analyzing Cues
		Solutions, Nursing Actions, and Outcomes
	FACTORS INFLUENCING MENTAL HEALTH CARE
		Attitudes and Beliefs
		Culture and Mental Health
		Availability of Mental Health Care
			Settings of Care
	MENTAL HEALTH DISORDERS
		Anxiety Disorders
			Prevalence and Characteristics
	USING CLINICAL JUDGMENT TO PROMOTE HEALTHY AGING: ANXIETY
		Recognizing and Analyzing Cues
		Solutions, Nursing Actions, and Outcomes
			Pharmacological Interventions
			Nonpharmacological Interventions
	POSTTRAUMATIC STRESS DISORDER
		Prevalence
		Symptoms
	USING CLINICAL JUDGMENT TO PROMOTE HEALTHY AGING: PTSD
		Recognizing and Analyzing Cues
		Solutions, Nursing Actions, and Outcomes
	SCHIZOPHRENIA
		Prevalence
		Symptoms
		Consequences
	USING CLINICAL JUDGMENT TO PROMOTE HEALTHY AGING: SCHIZOPHRENIA
		Solutions, Nursing Actions, and Outcomes
	PSYCHOTIC SYMPTOMS IN OLDER ADULTS
		Paranoid Symptoms
		Delusions
		Hallucinations
	USING CLINICAL JUDGMENT TO PROMOTE HEALTHY AGING: PSYCHOTIC SYMPTOMS
		Recognizing and Analyzing Cues
		Solutions, Nursing Actions, and Outcomes
	BIPOLAR DISORDER (BD)
	USING CLINICAL JUDGMENT TO PROMOTE HEALTHY AGING: BIPOLAR DISORDER
		Recognizing and Analyzing Cues
		Solutions, Nursing Actions, and Outcomes
			Pharmacotherapy
			Psychosocial Approaches
	DEPRESSION
		Prevalence
		Consequences
		Etiology
	USING CLINICAL JUDGMENT TO PROMOTE HEALTHY AGING: DEPRESSION
		Recognizing and Analyzing Cues
		Solutions, Nursing Actions, and Outcomes
			Nonpharmacological Approaches
				Integrated care.
			Pharmacological Approaches
			Other Treatments
	SUICIDE
	USING CLINICAL JUDGMENT TO PROMOTE HEALTHY AGING: SUICIDE
		Recognizing and Analyzing Cues
		Solutions, Nursing Actions, and Outcomes
	SUBSTANCE USE DISORDERS
		Alcohol Use Disorder
			Prevalence and Characteristics
			Gender Issues
			Physiology
			Consequences
			Alcohol Guidelines for Older Adults
	USING CLINICAL JUDGMENT TO PROMOTE HEALTHY AGING: ALCOHOL USE DISORDER
		Recognizing and Analyzing Cues
		Solutions, Nursing Actions, and Outcomes
	OTHER SUBSTANCE USE CONCERNS
		Cannabis Use
	OPIOID DRUG USE
		Prescription Drug Misuse
	KEY CONCEPTS
	Next-Generation NCLEX® (NGN) Examination–Style Questions
	CLINICAL JUDGMENT QUESTIONS AND ACTIVITIES
	CLINICAL JUDGMENT QUESTIONS AND ACTIVITIES
	RESEARCH QUESTIONS
	REFERENCES
31 - Ethics, Decision Making, and Mistreatment
	##
	ETHICS, HEALTH CARE, AND AGING
	DECISION MAKING
		Advance Care Planning
		Power of Attorney
		Durable Power of Attorney for Health Care
		Guardians or Conservators
		Barriers to Completing Advance Directives
		Living Wills
	MISTREATMENT OF OLDER ADULTS
		Undue Influence
		Neglect
			Self-Neglect
	USING CLINICAL JUDGMENT TO PROMOTE HEALTHY AGING
		Recognizing and Analyzing Cues
		Solutions, Nursing Actions, and Outcomes
			Education
			Prevention
			Assessment
			Early Intervention
			Emergency Response
			Advocacy
	KEY CONCEPTS
	Next-Generation NCLEX® (NGN) Examination–Style Questions
	CLINICAL JUDGMENT ACTIVITY
	RESEARCH QUESTIONS
	REFERENCES
32 - Relationships, Roles, and Life Transitions
	LATE LIFE TRANSITIONS
		Retirement
			Special Considerations in Retirement
			Retirement Planning
		Solutions, Nursing Actions, and Outcomes
			Death of a Spouse or Life Partner
	USING CLINICAL JUDGMENT TO PROMOTE HEALTHY AGING: LOSS OF SPOUSE OR LIFE PARTNER
		Recognizing and Analyzing Cues
		Solutions, Nursing Actions, and Outcomes
	RELATIONSHIPS IN LATER LIFE
		Friendships
	FAMILIES
		Changing Family Structure
		Multigenerational Families
		Family Relationships
		Types of Families
			Traditional Couples
				Divorce
			LGBTQ+ Families
			Older Adults and Their Adult Children
			Never-Married Older Adults
			Grandparents
			Siblings
			Fictive Kin
	CAREGIVING
		Caregiving in the LGBTQ+ Community
		Impact of Caregiving
		Caregiving of Individuals With Neurocognitive Disorders
		Spousal Caregiving
		Aging Parents Caring for Adult Children With Intellectual and Developmental Disabilities
		Grandparents Raising Grandchildren
	USING CLINICAL JUDGMENT TO PROMOTE HEALTHY AGING: GRANDPARENT CAREGIVING
		Solutions, Nursing Actions, and Outcomes
			Long-Distance Caregiving
	USING CLINICAL JUDGMENT TO PROMOTE HEALTHY AGING: CAREGIVER HEALTH
		Recognizing and Analyzing Cues
		Solutions, Nursing Actions, and Outcomes
			Special Considerations for Caregivers of Individuals With Neurocognitive Disorders
	NEXT-GENERATION NCLEX® (NGN) EXAMINATION–STYLE QUESTIONS
	CLINICAL JUDGMENT QUESTIONS AND ACTIVITIES
	RESEARCH QUESTIONS
	REFERENCES
33 - Intimacy and Sexual Health
	TOUCH
		Response to Touch
		Touch Zones
		Therapeutic Touch
	INTIMACY
	SEXUALITY
	SEXUAL HEALTH
		Factors Influencing Sexual Health
			Activity Levels
			Cohort and Cultural Influences
			Biological Changes
	SEXUAL RESPONSE
	SEXUAL HEALTH OF LGBTQ+ INDIVIDUALS
	USING CLINICAL JUDGMENT TO PROMOTE HEALTHY AGING: SEXUAL HEALTH OF LGBTQ+ INDIVIDUALS
		Recognizing and Analyzing Cues
		Solutions, Nursing Actions, and Outcomes
	INTIMACY AND CHRONIC ILLNESS
	INTIMACY AND SEXUALITY IN LONG-TERM CARE FACILITIES
	INTIMACY, SEXUALITY, AND DEMENTIA
	HIV/AIDS AND OLDER ADULTS
	USING CLINICAL JUDGMENT TO PROMOTE HEALTHY AGING: HIV
		Recognizing and Analyzing Cues
		Solutions, Nursing Actions, and Outcomes
			Sexually Transmitted Infections in Older Adults
	USING CLINICAL JUDGMENT TO PROMOTE HEALTHY AGING: INTIMACY AND SEXUAL HEALTH
	KEY CONCEPTS
	Next-Generation NCLEX® (NGN) Examination–Style Questions
	CLINICAL JUDGMENT QUESTIONS AND ACTIVITIES
	RESEARCH QUESTIONS
	REFERENCES
34 - Loss, Death, and Palliative Care
	##
	LOSS AND GRIEF
	GRIEF WORK
		The Loss Response Model
		Types of Grief
			Anticipatory Grief
			Acute Grief
			Shadow Grief
			Complicated Grief
			Disenfranchised Grief
		The Family
		Factors Affecting Coping With Loss
	USING CLINICAL JUDGMENT TO PROMOTE COPING WITH LOSS AND GRIEF
		Recognizing and Analyzing Cues
		Solutions, Nursing Actions, and Outcomes
			Impact
			Functional Disruption
			Search for Meaning
			Informing Others and Engaging Emotions
			Adaptation
			Memories Reframed and the Return of Equilibrium
	DYING AND DEATH
		The Family
		Palliative Care
		Hospice
		Hope
	USING CLINICAL JUDGMENT TO PROMOTE A GOOD DEATH
		Recognizing and Analyzing Cues
		Solutions, Nursing Actions, and Outcomes
			Biological and Physiological Integrity
			Safety and Security
			Belonging and Attachment
			Self-Esteem and Self-Efficacy
			Self-Actualization and Transcendence
			Promoting Equilibrium for the Family
			Nurses as Recipients of Care
	KEY CONCEPTS
	Next-Generation NCLEX® (NGN) Examination–Style Questions
	CLINICAL JUDGMENT QUESTIONS AND ACTIVITIES
	RESEARCH QUESTIONS
	34.1
		The Nurse and Medical Aid in Death
	REFERENCES
35 - Spiritual Health, Meaning, and Self-Actualization
	SELF-ACTUALIZATION
		Characteristics of the Self-Actualized
			Courage
			Altruism
			Humor
			Continuous Moral Development
			Self-Renewal
		Collective Self-Actualization
	WISDOM
		Characteristics of Wisdom
	CREATIVITY
		Creative Arts for Older Adults
	RECREATION
	BRINGING YOUNG AND OLD TOGETHER
		Solutions, Nursing Actions, and Outcomes: Self-Actualization and Aging
	SPIRITUALITY
		Spirituality and Religion
	USING CLINICAL JUDGMENT TO PROMOTE HEALTHY AGING: SPIRITUAL HEALTH
		Recognizing and Analyzing Cues
			Spiritual Assessment Tools
		Solutions, Nursing Actions, and Outcomes
			Nurturing the Spirit of the Nurse
			Faith Community Nursing
	TRANSCENDENCE
		Gerotranscendence
		Achieving Transcendence
			Time Transcendence
			Peak Experiences
			Meditation
			Hope as a Transcendent Mechanism
			Transcendence in Illness
	LEGACIES
		Types of Legacies
			Autobiographies and Life Histories
			Creation of Self Through Journaling
			Collective Legacies
			Legacies Expressed Through Other People
			Living Legacies
			Property and Assets
			Personal Possessions
	USING CLINICAL JUDGMENT TO PROMOTE HEALTHY AGING: SPIRITUAL HEALTH, MEANING, AND SELF-ACTUALIZAITON
	KEY CONCEPTS
	NEXT-GENERATION NCLEX® (NGN) EXAMINATION–STYLE QUESTIONS
	CLINICAL JUDGMENT QUESTIONS AND ACTIVITIES
	RESEARCH QUESTIONS
	REFERENCES
Index