AANN Core Curriculum, 7th Edition, Ch. 27 Neurological Conditions in Older Adults: Digital Version-Chapter 27

Chapter 27

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The chapter examines the growing need for specialized neurological care as the older-adult population expands. Aging affects the brain and nervous system through neuronal loss, reduced neurotransmitter availability, impaired remyelination, changes to white matter, and deterioration of the neurovascular unit and blood–brain barrier. These changes can reduce signaling and increase vulnerability to neurological disease. Sensory, balance, swallowing, sleep, thermoregulation, muscle strength, and mobility may also decline, raising risks of falls, injury, disability, and infection.<br /><br />Care begins with a comprehensive, multidisciplinary assessment of medical, cognitive, emotional, social, nutritional, and functional status. Nurses should evaluate basic and instrumental activities of daily living, cognition, mood, medications, comorbidities, support systems, and goals of care. Calm surroundings, adequate lighting, clear communication, and sufficient time help ensure accurate assessment.<br /><br />Common concerns include falls, delirium, dementia, depression, anxiety, frailty, infection, and elder mistreatment. Delirium prevention and management prioritize identifying its cause, supportive care, orientation, sensory aids, regular sleep routines, and early mobility; sedatives and antipsychotics should be used cautiously. Dementia care emphasizes predictable routines, independence, safety, meaningful activities, caregiver education, and community support.<br /><br />Polypharmacy is common and can increase adverse drug events, interactions, falls, and confusion. Age-related changes in drug distribution, metabolism, and elimination require careful medication review and monitoring, alongside attention to nutrition and hydration. Older adults’ reduced physiological reserve also makes them more vulnerable to rapid deterioration from illness or neurological crises.<br /><br />Nursing care should be individualized, respect cultural and spiritual preferences and patient autonomy, and account for the person’s life history and social context. Planning should address transitions of care, caregiver needs, advance directives, decision-making capacity, and palliative or end-of-life preferences.

Keywords

older adults

neurological care

aging brain

multidisciplinary assessment

delirium

dementia

polypharmacy

falls prevention

functional status

advance directives