Geriatric Care

JAMES VALLEY VOCATIONAL TECHNICAL CENTER

MYTHS• Elderly people are incompetent

and incapable of making decisions or handling their own affairs.

• Most elderly live in nursing homes

• All elderly people live in poverty

• Older people are lonely and unhappy

• Elderly do not want to work

• “Old Age” begins a 65

• Retirement ends your active life

Physical Changes of Aging

• Most physical changes that occur with aging are gradual and take place over a long period of time. In addition, the rate and degree of change varies among individuals.

• Factors such as disease can increase the speed and degree of the changes. Lifestyle, nutrition, economic status, and social environment can also have effects.

• If an individual can recognize the changes as a/an normal part of aging, the individual can usually learn to adapt to & cope with change

Integumentary SystemChanges• Production of new skin cells

decreases• Oil and Sweat glands

become less active• Circulation decreases

• Hair losses color, and hair loss occurs

• Skin becomes less elastic & dry• Itching is common• Dark yellow or brown colored

spots appear–Senile lentigines (liver spots)

• Fatty tissue layer of skin diminishes

• Lines and wrinkles appear• Nails become thick, tough, and

brittle• Increased sensitivity to

temperature

Care of Skin• Use mild soap• Bath oils or lanolin lotion• Bath or Shower once or twice a

week• Brush Hair daily

• Shampoo as often as needed for cleanliness and comfort

• Care for sore or injuries immediately

• Socks, sweaters, lap blankets, and layers of clothing will help alleviate the feeling of coldness

• Because of the need for oxygen and nutrients the elderly may experience:–Weakness–Dizziness–Numbness in hands & feet–Rapid heart beat

Circulatory System Care

• With circulatory changes:–Avoid strenuous exercise or over

exertion–Periods of rest–Moderate exercise, according to

individual’s tolerance

• Prevent the formation of a blood clot (thrombus)–Support stockings, anti-

embolism hose–DO NOT wear garters or tight

bands around legs\–If confined to bed

•ROM

• High Blood Pressure =–Diet low in salt–Decrease fat intake–Exercise as recommended by

physician

Respiratory Changes

• Respiratory muscles become weaker

• Rib cage more rigid• Alveoli thinner & less elastic

which decreases exchange of gases - emphysema

• Bronchioles lose elasticity• Changes in larynx lead to

higher pitched & weaker voice• Chronic diseases may decrease

the efficiency of the respiratory system even more severely

• Changes may cause the elderly to experience:–Dyspnea

•Breathing increases in rate•Difficulty coughing up secretions•Increases susceptibility to infections such as a cold or pneumonia

Respiratory Care• Alternate activity with periods

of rest• Proper body alignment &

positioning• Sleep in semi-fowlers position

–Use 2 or 3 pillows

• Avoid polluted air• Breath deeply & cough

frequently• May need continuous oxygen

therapy

Nervous System Changes

• Blood flow to brain decreases & there is a progressive loss of brain cells - - Interferes with–Thinking - Reacting–Interpreting - Remembering

• Senses of taste, smell, vision, & hearing are diminished

• Nerve endings less sensitive–Decreased ability to respond to

pain and other stimuli• Decrease in taste& smell

frequently affects appetite

• Changes in vision–Problems reading small print–Seeing objects at a distance–Decrease in peripheral vision–Decrease in night vision–Increased sensitivity to glare–Cataracts–Glaucoma

• Changes in hearing–Hearing loss usually gradual–Person may speak louder than

usual–Ask for words to be repeated–Not hear high frequency sounds–May not hear well in crowded

places

• Decreased sensation to pain & other stimuli = more susceptible–Burns–Frostbite–Cuts–Fractures–Muscle strain and other injuries

Digestive Changes• Fewer digestive juices and

enzymes produced• Muscle action becomes slower

& peristalsis decreases• Teeth are lost• Liver function decreases

•Dysphagia is frequent complaint–Less saliva–Slower gag reflex–Loss of teeth–Poor fitting dentures

• Slower digestion of food–indigestion

• Decrease peristalsis–Increase flatulence (gas)–Constipation

• Decrease sensation of taste–Poor appetite–Poor diet

Digestive Care• Good oral hygiene• Repair or replace damaged teeth• Relaxed eating atmosphere• High-fiber high-protein foods with

different tastes and textures• Seasoning to improve taste• Increased fluid intake

Urinary Changes• Kidneys decrease in size &

become less efficient• Bladder becomes less efficient

–May not hold as much–May not empty completely–incontinence

Urinary Care• Increase fluid intake

–Decrease before bedtime• Regular trips to bathroom• Easy to remove clothing• Absorbent pads

Endocrine Changes• Increased production of some

hormones and decreased of others

• Immune system less effective• BMR decreases• Intolerance to glucose

Endocrine Care• Proper exercise• Adequate rest• Medical care for illness• Balanced diet• Healthy lifestyle

Reproductive System Changes

• Decrease of estrogen / progesterone in female–Thinning of vaginal wall–Decrease vaginal secretions–Inflammation of vagina common

–Weakness in supporting tissue:•Uterus sags downward (Uterine prolapse)

–Breasts sag when fat redistributed• Decrease in Testosterone

–Slow production of sperm–Response to sexual stimuli slower–Testes smaller less firm

• Male and Female–Sexual desire may or may not

decrease• Advantages of sex in elderly

–Improves muscle tone & circulation

–Pain from arthritis seems to decrease

Reproductive Care• Understand physical and

psychological sexual needs of the elderly–Allow married couples to be in

the same room–Give privacy to consenting

elderly

Psychocosocial Changes

• Some individual cope with psychosocial changes, and others experience extreme frustration and mental distress

• Fears of a sick person:–Death–Chronic illness–Loss of function–Pain

• Dealing with fears created by an illness:–Listening–Patience–Understanding–Provide support

Confusion and Disorientation

• Six signs:–Talking incoherently–Not knowing their name–Not recognizing others–Wandering aimlessly–Lacking awareness of time or place

–Displaying hostile and combative behavior

–Hallucinating–Regressing in behavior–Paying less attention to

personal hygiene–Inability to respond to simple

commands or instructions

• Causes of temporary confusion / disorientation–Stress and/or depression–Use of alcohol or chemicals–Kidney disease–Respiratory disease–Liver disease–Medication

• Diseases:–CVA–Arteriosclerosis–Atherosclerosis

•Cause TIA’s ministrokes which result in temporary periods of diminished blood flow to the brain.

• Dementia–Loss of mental ability

characterized by a decrease in intellectual ability, loss of memory, impaired judgement, personality change, and disorientation

• Acute dementia–When the symptoms are caused

by temporary reason:•High fever, dehydration, hypoxia

• Chronic dementia–When symptoms are caused by

permanent, irreversible damage to brain cells

Alzheimer’s Disease• Form of dementia that causes

progressive changes in brain cells

Early Stages:• Memory loss• Mood & personality changes• Depression• Poor judgment• Confusion regarding time & place• Inability to plan and follow

through with ADLs

Middle Stages:• Nigh time restlessness• Mood swings increase• Personal hygiene ignored• Weight fluctuates• Paranoia & hallucinations • Full time supervision needed

Late Stages:• Total disorientation• Incoherent • Unable to communicate with

words• Loses control of bladder &

bowel functions

• Develops seizures• Loses weight despite eating a

balanced diet• Becomes totally dependent• Lapses into a coma• Dies

• Certain aspects of care should be followed with any confused or disorientated individual. Provide a/an safe and secure environment, follow the same routine, keep activities simple and last for short periods of time.

Avoid loud noises, crowded rooms, and excessive commotion. Promote awareness of person, time, and place by providing reality orientation (RO)

Reality Orientation:• Address person by name preferred • Avoid: sweetie, baby, honey• State your name, correct elderly if

calls you by the wrong name• Make reference to day, time, place• Use clocks, calendars, bulletin bd.

• Keep individual oriented to day night cycles:–Regular clothes during the day–Open curtains during the day]–Close curtains at night–Pajamas at night

• Speak slowly, clearly / ask clear & simple questions

• Never rush or hurry the individual

• Repeat instructions patiently, allow time for ind. to reaspond

• Encourage conversations about familiar things or current events

• Encourage use of tv, radio without overstimulating them

• Be sure ind. uses sensory aids• Keep familiar objects in view

Avoid moving furniture & belongings

• Do not agree with incorrect statements

• Do not hesitate to touch communicate with person

• Avoid arguments• Encourage independence and

self help whenever possible

Meeting the Elderly Needs

•Culture: the values, beliefs, ideas, customs, and characteristics that are passed from one generation to the next.

• Areas affected by an individual’s culture:–Language–Food habits–Dress–Work–Leisure activities–Health care

• The spiritual beliefs and practices of an individual is called their religion. It is important to accept an individual’s belief without bias, and that health care workers not force their own religious beliefs on the ind. being cared for.

• Respect and Consideratin of a persons religious beliefs–Proper treatment of religious

articles–Allow person to practice religion–Honor request for special food–Provide privacy during clergy

visits

• Abuse–Physical–Verbal–Psychological–Sexual

• Report any abuse observed to proper agency

• Reasons elderly do not report abuse–Feel they deserve the abuse–Want to protect abuser

•Ombudsman is a specially trained individual who works with the elderly and their families, health care providers, and other concerned individual. To improve quality of care and quality of life.