NCLIP

Healthcare Concerns and Decisions of Older Adults

3 min read

Healthcare Concerns and Decisions of Older Adults

Key Points

  • Older adults often manage multiple chronic conditions with interacting treatment demands.
  • Access barriers include insurance limits, transportation gaps, digital literacy, and cultural stigma.
  • Healthy aging depends on function, social connection, nutrition, medication safety, and mental health support.
  • Health literacy strongly affects informed consent, adherence, and self-management outcomes.

Pathophysiology

Older adults commonly experience multimorbidity, where chronic illnesses and treatment plans interact and increase physiologic risk. Age-related reduction in reserve across organ systems makes medication adverse effects, drug-drug interactions, and treatment burden more consequential.

Population-level burden is high for hypertension, dyslipidemia, arthritis, diabetes, kidney disease, heart disease, depression, and neurocognitive disorders. These patterns make coordinated longitudinal care, rather than single-condition treatment, a core nursing focus.

Classification

  • Clinical complexity: Coexisting medical, psychiatric, and functional issues requiring coordinated management.
  • Access complexity: Insurance, transportation, technology, cultural, and financial barriers to care.
  • Decision complexity: Balancing quality of life, safety, prognosis, and client preferences in care planning.

Nursing Assessment

NCLEX Focus

Prioritize barriers to care, health literacy level, and the client’s decision-making goals before teaching or planning interventions.

  • Assess chronic disease burden, medication list completeness, and potential interaction risk.
  • Assess functional status for ADLs/IADLs, caregiver availability, and safety needs.
  • Assess access barriers: transportation, affordability, provider availability, and digital access.
  • Assess personal and organizational health literacy needs using plain-language teach-back.
  • Assess social supports, cultural preferences, and advance-care-planning status.

Nursing Interventions

  • Coordinate interprofessional communication to reduce fragmented care and prevent errors.
  • Use clear, low-literacy education with repetition, written summaries, and teach-back.
  • Link clients to community resources (aging services, meal programs, insurance counseling, caregiver supports).
  • Support self-management plans with medication schedules, reminders, and symptom-monitoring tools.
  • Integrate family/care partners into planning when appropriate to client preferences.

Access and Literacy Risk

Poor access and low health literacy can cause preventable deterioration, medication errors, and avoidable readmissions.

Pharmacology

Polypharmacy is common in older adults and increases risk for adverse events, cognitive changes, falls, and nonadherence. Nurses should perform routine medication reconciliation, screen for duplications and high-risk combinations, and reinforce indication-dose-timing understanding for all prescribed and over-the-counter agents.

Clinical Judgment Application

Clinical Scenario

An older adult with hypertension, CKD, and depression misses follow-up visits and reports confusion about medications.

Recognize Cues: Missed care, multimorbidity, and regimen confusion indicate high-risk care fragmentation. Analyze Cues: Access barriers and low health literacy are likely driving poor self-management. Prioritize Hypotheses: Safety, adherence support, and coordinated follow-up are immediate priorities. Generate Solutions: Simplify regimen teaching, arrange transportation support, and involve care partners. Take Action: Complete medication reconciliation, teach-back education, and community resource referral. Evaluate Outcomes: Improved appointment adherence, medication accuracy, and symptom stability.

그래프 뷰