Geriatrics 6789

8/6/2019 Geriatrics 6789

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Needs of elderly

PRESENTATION BY

Ms. Poornima Nahar

Clinical Instructor,

CON, DMCH, LDH.


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A profession in geriatric social work

continues to be territory with a frontier that

just keeps growing. This work

provides a real opportunity to actually make a

positive difference in the lives of older adults

& their family members.


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Major challenge facing society is how we can maintain health

and quality of life in an ageing population .

Once you reach the dreaded 70s all sorts of ailments seem to

dog your footsteps. The well being of an individual does not merely pertain to

physical health but also to mental health.


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HOW TO CARE FOR ELDERLYHOW TO CARE FOR ELDERLY

Many people are wary of elderly people.

The reality is everyone gets old, and, as

we age, our bodies begin to lose that

youthful essence. SO, It's important

to give them respect and compassion.


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The first thing to remember whencaring for an elderly person is that

their physi l ic l ppe r ce has

rse e . Hearing, vision and touch

You may need tospeak louder.

You w ill al so need to mak eallowance for their poor vision.

Furthermore, the elderly are oftenmore sensitive topainand touch.


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SecondSecond ofof allall,, the elderly begin to losecontrol over certain aspects of their life

including bodily f ctions and memory.

You need to remember that this is not theirfault, and it is probably more frustrating for

them than it is for you. So,

Be sensitivebeunderstanding and

be discreetabout their trouble.


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ThirdThird,, an elderly people will go throughemotional changes as well.

They will also be frustrated about becoming

dependent on someone else ,especially after

an entire lifetime of doing things themselves.

They may want to talk about it or may not; YouYou needneed totobebe compassionatecompassionate andand listenlisten

YouYou needneed totorespectrespect theirtheir wisheswishes..


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HOW OLD AGE INSULTS A PERSONHOW OLD AGE INSULTS A PERSON

Loss ofphysic

alattracti

ve-ness

Loss ofsuppor

tingperson

s

Lossof

statu

s

L

loss ofuseful

andrespect

edroles

Loss ofphysic

alhealth

andvigor

Changes inliving

environ-ment


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ASPECTS

3.SOCIAL3.SOCIAL2.2. PSYCHOPSYCHO--

LOGICALLOGICAL

1.PHYSICAL1.PHYSICAL


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PHYSICAL ASPECTSPHYSICAL ASPECTS

As aging occurs, certaincertain physicalphysical changeschanges occ rocc r inin allall individualsindividuals hichwhichareare normalnormalpartpartofofagingaging processprocess..

The rate and degree of change varies among individuals.

LifestyleLifestyle ,nutrition,nutrition ,, economiceconomic statusstatus ,social,social environmentenvironment andand limitedlimited

accessaccess toto medicalmedical carecare cancan havehave anan effectseffects..

IfIf anan individualindividual cancan recognizerecognize thesethese changechange asas aa normalnormal partpart

ofof aging,aging, thethe individualindividual cancan usuallyusually learnlearn toto copecope withwith thethe

changeschanges..


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Integumentary systemIntegumentary system

MostMost obviousobvious effectseffects ofof agingaging areare seenseen inin thethe

integumentaryintegumentary systemsystem..

ProductionProduction ofof newnew skinskin cellscells decreasesdecreases &&

sebaceoussebaceous andand sudoriferoussudoriferous glandsglands becomebecome lesslessactiveactive ..

TheThe hairhair losesloses colorcolor andand hairhair lossloss occursoccurs.. TheThe

skinskin becomesbecomes lessless elasticelastic andand drydry ..

TheThe nailsnails becomebecome thick,thick, toughtough andand brittlebrittle..

CirculationCirculation toto skinskin decreasesdecreases andand causescauses

coldness,coldness, drynessdryness andand poorpoor handlinghandling ofof injuredinjured

tissuetissue ..

HypothermiaHypothermia cancan bebe aa seriousserious problemproblem forfor

elderlyelderly..



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INTEGUMENTARY SYSTEMINTEGUMENTARY SYSTEM--NEEDS Good skin, nail, hair care is essential

Mild soaps should be used

Bath oils, lanolin lotions are recommended to

combat dryness and itching

Partial baths on alternate days are recommended

Any sores or injury to skin should be cared for

immediately.

Proper diet, exercise, good hygiene, decreased

exposure to sun and proper skin care helps slow and

even decrease the normal physical changes in the

integumentary system


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MUSCULOSKELETAL SYSTEM

As aging occurs, muscle lose tone, volume, strength.

Osteoporosis and arthritis is the most common

problems.

The rib cage becomes more rigid and vertebral

column press close together.

These changes cause the elderly people to

experience a gradual loss in height, weight and

decreased mobility.

Sense of balance is less and falls occur easily and

results in fractures of arms, legs and hips.

Fine finger movements like buttoning clothes or

tying shoes are difficult to perform.


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MUSCULOSKELETALMUSCULOSKELETAL SYSTEMSYSTEM--NEEDSNEEDS

ROM exercises help to maintain muscle strength.

Encourage them to exercise as much as their

physical condition permits.

A diet rich in protein, calcium and vitamins isneeded to slow loss of minerals from bones and

maintain muscle structure.

Bars in the bathrooms, hand rails in the halls &

use of walkers and quad canes is frequently

recommended Well fitted shoes with non slip soles and flat heels

should be worn to prevent falls

A consultation with occupational therapist can

provide elderly individuals with information on

latest adaptive devices to maintain independence



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The safety of t

he elderly is a major concern in ourlives, as falls and fire are common accidents among

the older generation.

Precautionary steps taken at home are

General precautions

-Use nightlights for the stairs and hallways. Use illuminatedlight switches. Clap-on, clap-off light systems are

particularly convenient.

- Stay organized and tidy. Keeping things in generally the

same place will facilitate in, not only locating them, but also

creating a route around the house to which one can

accustom oneself.- Keep the phones in easy reach in the kitchen, the living

room, and the bedroom. Consider keeping a wireless

phone. Have a list of emergency numbers handy.

These rules of thumb should tighten home security for the

elderly.


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Falls

Falls,Falls, trips,trips, andand slipsslips areare somesome ofof thethe mostmost frequentfrequent

causescauses ofof physicalphysical injuryinjury inin thethe elderlyelderly.. To lower the

risk of falls, consider the following safeguards.

Install solidhandrails on the stairs, in the bathroom, etc.

Putnon-slip mats on the bathroom floorandin the tub

Place low-pile rugs in allhazardous areas and putnon-

slip mats underall rugs.

Thresholds to anydoorway should be as low as possible.

Keep all wires and cables tucked in and/or close to the

walls.

Check that there are no holes in the yard area. Check

that there are no loose boards on the porch.



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Home fires are also quite common in homes of the

el erly. Here are a few ti s to counter such hazar s.

Check the fire alarms frequently to be certain they are in

good working order. Change the batteries as soon as it is

discovered they are dead.

eep a fire extinguisher close at hand.

Maintain any and all exits clutter-free.

Use kitchen appliances that are clearly marked. All the

knobs and switches should be easily understood and

accessible. Make sure no electrical appliances are near any sinks or

bathtubs.

Check the wires of all appliances. They should all be

properly insulated.

Use safety plugs for electrical sockets that are not in use



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CIRCULATORYCIRCULATORY SYSTEMSYSTEM

Heart muscles become less efficient at pushing

blood into arteries .

Blood vessels become narrow and blood flow tobrain and other vital organs decreases.

Blood pressure may increase or decrease.

They are aware of changes when exercise, stress,

excitement, illness and other similar events call forincrease in oxygen demand.

During these periods they experience weakness,

dizziness, numbness in hands and feet and rapid

heart rate



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CIRCULATORYCIRCULATORY SYSTEMSYSTEM--NEEDS

Need to avoid strenuous exercises and need

rest periods during day.

Need moderate exercise, according to

individuals ability to tolerate, does stimulate

circulation and prevent formation of

thrombus or blood clot.

If Hypertension is present, a diet low in salt isrecommended



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RESPIRATORY SYSTEM

Respiratory muscle becomes weaker with age .The rib

cage becomes more rigid.

The alveoli, air sacs in the lungs, become thinner and

less elastic which decreases the exchange of gasesbetween the lungs and the blood stream.

The bronchioles, or air tubes in the lungs also loss

elasticity. Changes in larynx leads to weaker voice.

These changes cause the elderly individuals to

experience dyspnea or difficult breathing. Breathing

becomes rapid and they have difficulty coughing up

secretions .

This makes them more prone to respiratory infections

like pneumonia, cold , emphysema and bronchitis.



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NERVOUS SYSTEM

Blood flow to brain decreases and their progressive loss

of brain cells.

This interferes with thinking, reacting, interpreting and

remembering.

The sense oftaste, vision , hearing diminish.

Nerve endings are less sensitive and there is a decreased

ability to response to pain and other stimuli.



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Sensory impairment

50%of older people suffer

from deterioration o f eye

sight. Vision cause problem in

reading small print and

seeing objectatdistance.

There is decrease inperipheral vision and night

vision.

Elderly individuals are more

prone to cataract and

glaucoma.

NEEDS

Spectacles are worn & Large printed

books are provided bymany libraries

Lighting needs to be good and colors

light and cheerful. This helps

compensate for failing eyesight and

improves mood

Use sheer curtains orpolarized glass to

minimize windowglare.

Use contrasting colors to help

differentiate depth

Medical treatment for cataract and

glaucoma


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Hearing impairments

Hearing impairments are

less frequent but can be

annoying to all concerned .

The individual may speak

more loudly than normal,

sk for words to be

repeated Inability t o hear high

fre uency sounds such as

ringing ofa telephone

NEEDS

If a person has hearing aid make

sure they are on and working

Speak normally or lower the pitch ofyour voice

Minimize all the background noise

& sit face to face to facilitate lip

reading

Use pictures ,models or writtenkeywords to reinforce verbal

teaching

Select video or slides or tape

presentation that use speakers with

deeper voices


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Cognitive impairment

Individuals with deficits inmemory, language, abstract

thinking and judgments

have great difficulties

executing ADLs.

These individuals needs

supervision and cueing.

NEEDS

Slow the pace and allow extra time for

the person to response & give examples

related to life experiences Reinforce with printed material & keep a

diary and get into the habit of using it

regularly

Alarm clocks & electronic memory aids

are also available(Alarm buzzer can be

programmed to remind the user atappropriate time)

Have a wipe clean note board in the

house and keep notes into it

Mnemonics is another way of improving

memory(images and pictures seem

easier to recall words)



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URINARY SYSTEM

In elderly individuals as there is decreased sensation and also due than to

muscle weakness they does not empty their bladder completely and urine

is retained ,causing bladder infections.

Nocturia or urination at night is common

Males frequently experience enlargement of prostate gland ,loss of muscle

tone results in incontinence or inability to control urination .

Many individuals decrease fluid intake to cut down on the frequent need

to urinate. This cause dehydration, kidney disease and infection.



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URINARY SYSTEM-NEEDS

Encourage to increase fluid intake to improve kidney function

To prevent nocturia most fluids should be taken beforeevening

Regular trips to bathroom, wearing easy to remove clothing,and using absorbent pads can help in mild incontinence.

Some elderly needs bladder training programs to increasebladder capacity and leads to more control over urination.

An indwelling catheter may be needed if all urinary control islost



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ENDOCRINE SYSTEMENDOCRINE SYSTEM Changes in endocrine system results in

increased production of some hormones, such as parathormone and thyroid

stimulating hormones and

decreased production of other hormones, such as thyroxin ,estrogen,progesterone and insulin.

As Hormones affect many body functions, several physical changes mayoccur.

The immune system of body is less effective

The BMR decreases, resulting in complaints of feeling cold, tired and less alert

Intolerance to glucose can develop resulting in decreased blood glucose levels.



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ENDOCRINE SYSTEMENDOCRINE SYSTEM--NEEDS

Proper exercise,

adequate rest,

Medical care for illness,

a balanced diet and

a healthy lifestyle all help to increase the effects causedby changes in hormone activity.



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REPRODUCTIVE SYSTEMREPRODUCTIVE SYSTEM

The decrease of estrogen and progesterone in female

decreases in vaginal secretions. Vaginal infectionsbecome more common.

Decreasing levels of testosterone in the male slow

the production of sperm. The seminal fluids areproduced in smaller amounts

Sex desire and need do not diminish with age.



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REPRODUCTIVE SYSTEMREPRODUCTIVE SYSTEM--NEEDS

The health care workers must

respect the privacy of elderly

married couples

Allow them to meet their sexualneeds as in long-term care facilities

they are not allowed to live together.



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Studies have shown that older people perform less well on

intelligence tests when compared with younger ones.

Memory loss is feature commonly associated with old age.

When this occurs in elderly individual who are already

stressed by physical changes or circumstances, it can be

traumatic.


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Stress or depression caused by physical and psychosocial

changes

Use of chemicals or alcohols .Some medications and drugs

which can sometimes accumulate in body and causeconfusion and disorientation

kidney disease which interferes with electrolytebalance

liver disease which interferes with metabolize

Even poor nutrition or lack of fluid intake caninterfere with mental ability


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Other diseases or damages that can cause permanent confusion ordisorientation are:

CVA (which damages brain cells).

Arteriosclerosis (a condition in which the walls of blood vesselsbecome thick and lose their elasticity)

Dementia also called as brain syndrome (loss of mental ability)

Alzheimers disease (form of dementia that causes progressivechanges in brain cells.)


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AA primaryprimary concernconcern isis toto provideprovide safesafe andand securesecure environmentsenvironments

Dangerous objects suchsuch asas drugs,drugs, poison,poison, scissors,scissors, knives,knives, razors,razors, andand guns,guns,

powerpower tools,tools, cleaningcleaning solutionsolution andand matchesmatches andandlighterslighters shouldshould bebe keptkeptoutout

ofof reachreach and in a locked area.

If the individual tend to wander, doors and windows should be secure. InIn

severesevere casescases specialspecial sensorssensors mustmust bebe attachedattached toto thethe legleg oror wristwrist ofof thethe

disorienteddisorientedindividualindividual..

Meals, baths, dressing, walks, and bed time should eacheach occuroccur atat

approximatelyapproximately thethe samesame timetime eacheach dayday..

Activities should be kept asas simplesimple asas possiblepossible and last for short period of

time

Loud noises, crowded rooms and excessive commotion can cause the

individual to become agitated and even more disoriented.


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RealityReality orientationorientation consistsconsists ofof activitiesactivities thatthat helphelp totopromotepromote awarenessawareness ofof person,person , time,time, andand placeplace.. SomeSomeaspectsaspects ofof realityrealityorientationorientation areare::

Be calm and gentle when approaching the individual

ddress the person by the name theyprefer.

voidthe terms such as sweetie, honey, baby

State your name and correct the person if he or shecalls you wrong name


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Speak slowly and clearly and ask simple and clear andsimple uestions

Never rush orhurry the individual

Repeat instructions patiently. llow time for the individualto respond.

Encourage conversation about familiar things or currentevents

Encourage use o f T.Vor radio but avoid over stimulatingthe individual

Make sure individualuses sensoryaids such as glasses andhearing aids


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Make constant references to daytime and place. e.g.,it is 8:00 Tuesdaymorning andtime forbreakfast

Use clock ,calendars and information boards to pointout time, dayandactivities

Make a constantandlimitedroutine

Keep the individual oriented to day night cycles.uring the day encourage the person to wear regularclothes. lso open the curtains andpointout sunshine.

t night close the curtains, use night lights andpromote rest.


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The socialneeds which are common to all individuals are

EmotionalEmotionalsecuritysecurity andandaffectionaffectionmetby receiving love and byliving in the worldwhere things are predictable .

SocialSocial recognitionrecognition andand statusstatus met by receiving respect frompeople who counts in one world

A sensesense ofofworthworth andand selfself respectrespect, met by living up to onesideals.

Ade uate foodfood ,clothing,,clothing, sheltershelterandand healthhealthThese needs are notmetandthe reason lie in the fact thatboth

the human body and human society insult the person as hegrows olderand make itdifficult forhim to meethis needs.


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Adjustment to death of spouse-

If a woman loses her husband, she may have to

move from her house to smaller place, learn about business matters,

and above all she has to learn to be alone.

If a man has the same adjustment to make to loneliness , he

may have to learn to cook,

keep house and to keep his clothes in order.


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Adjustment to death of spouse-

The solution of this task run through the range of living on alone in the oldhome,

moving into a smallhome, living in a rooming house,

moving in with brotheror sisters,

living with children,

remarrying,

going to an olds people home.

Every solution re uires unlearning ofoldways and learningofnew ways, ata time when learning comes harder than itdidin earlier years.


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Adjustment to loss of employment and reduced income

In a society a jobjob isis thethe axisaxis ofof lifelife for most men and for many

women. If the occupation goes, the individual feel that hedoes not count & he is not a worthy member of society.

SomeSome peoplepeople fill fill thethe vacuumvacuum createdcreated byby retirementretirement inin theirtheir

liveslives withwith usefulusefulandandinterestinginteresting leisureleisure timetime activityactivity

findfindaa partpart timetime jobjob whichwhich keepskeeps themthem busybusyandandhappyhappy..


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Adjustment to decrease physical vigor

The human body ages in almost every one of its cells and

cellular systems.

The cells gradually lose their self repairing properties

They slow down in their nutritional processes.

TheThe individualindividual mustmust learnlearn newnew wayway ofo f lifelife thatthat isis inin

harmonyharmonywithwith hishis decreaseddecreasedstrengthstrength andandhealthhealth..


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Satisfactory social roles, which bring social recognitionand self respect

It lies within the power of the individual to create forhimself some of the satisfying social roles , suchsuch asas thosethose ofof friendfriend,,

membermemberofof socialsocial cli ue,cli ue,

constructiveconstructive useruserofof leisureleisure time,time,

informedinformedcitizencitizen ,, activeactive churchchurch membermember..

Care provided to elderly individual should allow asmuch independence as possible.


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A chance to earn a living or economic security

Older people need economic security, but under

existing conditions relatively few of them can live in

reasonable comfort on their own life time savings.

TheyTheyneedneedwork,work, ifif theytheyareare ableable toto work,work, oror

AA systemsystem ofof pensionspensions whichwhich givesgives themthem reasonablereasonable

economiceconomic securitysecurity..


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Social and recreational facilities

Just as the community provides recreational facilities andleadership to meet the needs of youth, so it should meet the

needs of older people with analogous facilities through

municipalmunicipal recreationrecreation departments,departments,

churches,churches,

schoolsschools andand

clubsclubs..

At a minimum, the older people require meeting places,equipments for games, leadership for recreation instruction in

art and crafts.


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Making satisfactory physical living arrangements

The principal values that older people look for in housing are

quiet,

privacy,

independence ofaction,

nearness to relatives andfriends,

residence among own culturalgroup,

cheapness,

closeness to transportation lines and

communal institutions.

MostMost peoplepeople tendtend toto clingcling toto establishedestablished housinghousing arrangementsarrangements untiluntil theythey

becomebecome veryveryunsatisfactoryunsatisfactory..

AllowAllow themthem toto bringbring theirtheir favoritefavorite piecespieces ofof furniture,furniture, pictures,pictures, television,television,

radiosradios andand otherother personalpersonal itemsitems toto longlong termterm facilitiesfacilities.. ThisThis willwill allowallow

individualindividual toto adjustadjust toto newnewenvironmentsenvironments andandtoto copecope withwith changeschanges ..


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Health services

For older people therethere shouldshould bebe guaranteedguaranteed healthhealthserviceservice toto whichwhich theythey cancan turnturn asas aa mattermatterofof rightright..

Whether this is financial through an insurance

company or through public supported fund .


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Providing care to elderly can be challenging but rewarding

experience.

The needs of elderly dont differ greatly from the needs of any other

individual. They have same physical and psychological needs as any

other person at any age .

these needs are sometimes intensified by physical and psychological

changes that disrupt normal life pattern.

When this occur, the el erly in ivi ual


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Geriatrics 6789

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Transcript of Geriatrics 6789