• by 2030 one in five people will be over 65
• five women to two men 
• one in ten every race other than white
• 2050 it will be up to 2 in 10 more equity

fastest growing segment of older adults in US is 85 and older

• the future population of older adults will be more ethnically and racially diverse with minority groups. Everyone except non-Hispanic single race whites representing 50% of the population in 2050

• a way to organize 

• P= promblem
• E= Etiology ( infection, a direct cause,)
• S= signs and systems

Example of PES

Problem- Infection

Etiology- open wound, a weakened immune system, decrease blood ciculation to the sight

sign- a fever/ Symptom- I dont feel 

while older adults at risk for nutritional deficiencies?

• loneliness
• diminished sense of taste and smell
• tooth loss and poorly fitted dentures
• lack of transport to to go to a store and buy the food

• the aging can affect absorption, distribution, metabolism, and secretion of drugs from the body

• this includes small amounts of total body water, and increase ratio adipose tissue to lean body mass, a decreased albumin level and a decreased cardiac output

• a decrease in liver size, which means a decrease in liver, blood flow in a decrease in liver enzyme activity. These changes can result in increased plasma concentration of the blood

• is the use of multiple medications. This is a risk factor for acute confusion, delirium and depression in older adults
• most, results of polypharmacy are increased adverse drug reaction and drug to drug interaction

• they commonly use nonprescription drugs such as antacids, cold and cough preparations, laxatives, vitamin supplements, often without consulting a health care provider

• not declared incompetent by a court of law
• has to be 18 years of age or older
• pregnant or a married minor
• he legally emancipated free minor with self-supporting

• he or she is legally competent and can make clinical decisions
• this is determined by a person's ability to identify problems, recognize options, make decisions and provide the rationale supporting the decision

physical factors that put older adults at risk for depression

Illness and disability; chronic or severe pain; cognitive decline; damage to body image due to surgery or disease.

what is geriatric Depression scale

• patient selects yes or no to 15 questions
• score of 10 or greater is consistent with a possible diagnosis of clinical depression 

• an acute confusional state
• onset is fast
• duration hours to less than a month
• cause multiple such as surgery, infection, drugs
• reversibility is usually
• remove or treat the cause
• reorient the patient to reality, provide a safe environment

•  chronic progressive cognitive decline
• the onset is slow
• duration could last from months to years
• cause unknown
• none reversibility
• for nursing intervention reorientation is not affected in the last stages
• acknowledge patients, feelings
• to not argue

• is there evidence of an acute change in mental status from the patient's baseline
• does the patient have difficulty focusing attention or keeping track of what is being said
• is the patient's thinking and conversation disorganized or incoherent
• altered level of consciousness?
• the diagnosis of delirium by the CAM is the presence of features one and two and either three or four