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The interviewee is a woman aged 72 named M. She has a rather active life, both social and personal. M. lives with her husband in a rural community. Their younger daughter and her family (husband and two teenage daughters) live with them. M. worked as a literature teacher and retired ten years ago. She has always been interested in healthy lifestyles. Probably, this fact conditioned her good health for her age. She has been doing her morning exercises for more than 50 years and is not going to stop. They have a family tradition of long weekend walks with her husband, and, at present, their granddaughters accompany them. The interviewee believes that moderate physical activity is the best preventive measure from diseases. M. is the head of a reading club in the community center. This activity provides her with an opportunity for self-realization and the feeling of social significance that is crucial for the mental health of older adults. M. regularly visits her general practitioner and dentist for examination. She demonstrates treatment compliance in case of necessity but still believes that prevention is better than treatment. While she observes some physical age-related changes such as wrinkles, mild hypertension, and partial hearing loss, her mental functions are still not affected.
M. can be considered a healthy woman for her age. She does not observe any serious chronic age-related diseases. She only reports having some normal age-related changes that do not disturb her much. She has had a visual impairment since the age of 26, so her myopia is not age-related. The most significant age-related changes in the patient are hypertension and hearing impairment.
M. has been observing mild hypertension during the last 15 years. Hypertension is found among more than half of people over 60, women in particular (Nagaratnam, Nagaratnam, & Cheuk, 2016). It is characterized by “repeatedly elevated blood pressure, a systolic blood pressure above 140 mmHg with a diastolic blood pressure above 90 mmHg” (Nagaratnam et al., 2016, p. 14). An increase in blood pressure is typical of normal aging. According to the Framingham Study (as cited in Nagaratnam et al., 2016, p. 14), the risk of developing high blood pressure after the age of 55 is over 90%. A physiological explanation is that in the process of normal aging, intimal thickening of the arteries is observed. At the same time, vascular elasticity decreases, and stiffness increases. Consequently, stiffness of the central artery conditions the increase of systolic pressure and decrease of diastolic (Nagaratnam et al., 2016). On the whole, heart efficiency lessens with aging and the same activities make it work harder than before. While the heart muscle grows, the decline of energy can be observed.
M. manages this condition well. It slightly influenced her quality of life because she cannot be as active as she was at a young age. The woman should be careful and interchange periods of activity with rest to avoid blood pressure increase.
Another age-related change that M. lives with is mild hearing impairment. She noticed it about three years ago. Age-related hearing loss is provoked by certain structural and pathophysiological processes related to the alterations in-ear functional components. These changes comprise “thickening of the eardrum, sclerotic changes of the muscles and joints in the middle ear, decreasing number of hair cells in the inner ear and degeneration of the eighth nerve and the neurons of the medullary center” (Nagaratnam et al., 2016, p. 357). The ossicular chain becomes stiff and the tympanic membrane becomes thinner and stiffer. Moreover, the cochlea is also characterized by age-related changes that condition hearing loss. Also, alterations in tone are possible and speech can become less clear. These changes generally are not observed before the age of 55.
M. states that her partial hearing impairment does not have any impact on her life. It brings some discomfort when someone speaks in a low voice during the meetings of the reading club. However, bad hearing does not influence her home life.
Discussion of the Age-Related Changes
Hypertension is frequent among older adults. This condition is dangerous because it can cause more serious diseases such as heart failure, stroke, or heart disease. Moreover, it can negatively influence the quality of life. Zyoud et al. (2013) provided a cross-sectional study dedicated to treatment adherence in patients with hypertension and the related quality of life. The research proved that for hypertensive patients, the increase of the adherence level from low to high is positively correlated with the health-related quality of life (Zyoud et al., 2013). Another study regarding common conditions of older adults, including hypertension, was conducted by Simpson, Simpson, and Dubno (2015). In a cohort study, 47.2% of respondents aged 60 to 90 reported having hypertension. Most of them had other comorbid conditions that negatively influenced the quality of life. It can be concluded that M. manages her condition better than the average patient. It can probably be explained by the fact that M. does not need regular treatment and is not dependent on medication.
Some researchers are investigating the issue of health-related quality of life and hearing loss in older adults. Thus, Bernabei et al. (2014) review hearing loss and cognitive decline in older adults. The authors state that the loss of hearing can stimulate other age-related changes such as cognitive decline. This condition, in turn, can increase the risk of dementia and influence the decrease of life quality.
Dalton et al. (2013) investigated hearing loss as one of the frequent conditions observed in older adults. This condition can cause communication difficulties and thus negatively influence the quality of life of such patients. According to the research findings, “59% of people with a mild hearing loss and 80% of people with a moderate to severe hearing loss report communication difficulties” (Dalton, 2013, p. 666). The comparison of the interviewee’s self-report and the research results leads to the conclusion that M. manages the condition of partial hearing impairment better than the majority of patients because she did not report having any communication difficulties.
Implications for Gerontological Nursing
Gerontological nursing is a significant aspect of nursing practice. Older adults become a vulnerable population due to the developing age-related changes and chronic conditions that they are not able to manage. Nursing implications aimed at the improvement of health-related quality of life can help promote successful and healthy aging.
Thus, nursing interventions can be aimed at hearing enhancement (Touhy & Jett, 2014). Older adults are not often interested in technical health-related discoveries. Consequently, a nurse can help with the choice of hearing aids to improve hearing and thus increase the quality of life. Another intervention is not executed by a nurse but can be recommended to an elderly patient with serious hearing impairment. Thus, a nurse can inform you about the possibility to use cochlear implants. Moreover, nursing activities concerning patients with hearing loss can teach patients to use and take care of hearing aids. However, before recommending any aids or treatment, a gerontological nurse should assess the hearing ability to provide efficient communication with a patient.
Gerontological nursing interventions are crucial for patients with hypertension. These people need to control blood pressure and not all of them can do it independently. Thus, it is a task of a nurse to provide measurements and the consequent patient education aimed at the explanation of behavior peculiarities necessary for the prevention of hypertension. Moreover, a professional nurse should assess the condition of the patient and advise visiting his or her general practitioner in case hypertension cannot be managed without serious treatment.
Role of Clinical Nurse Leader in Older Adults’ Care
A specific role in older adults’ care belongs to the Clinical Nurse Leader. It is distinct from the nursing implications discussed above. According to Holm and Severinsson (2013), the role of efficient gerontological leadership is revealed in six aspects such as “ability to change the attitudes towards older persons; building trust; ensuring efficacy in management decisions; lack of knowledge about how to overcome relational challenges; health system collaboration to achieve goals and visions; and staff members’ experiences of the meaning of and possibility to influence their work” (p. 218). Thus, clinical nurse leaders can guide the process of care, provide patients with the necessary knowledge to manage their age-related changes, and educate nursing staff to enable them to provide efficient patient education to improve patient outcomes.
On the whole, older adults treat their age-related changes differently. Some manage them successfully, and others report a significant decrease in the quality of life. Nursing interventions aimed at patient education concerning age-related changes and their management can be helpful for older adults. Moreover, appropriately guided interventions can significantly increase patient satisfaction and quality of life.
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