Chapter 11 Care of the Older Person Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.

The Older Person  People live longer than ever before.  Chronic illness is common in older persons.  Disability often results.  Many older persons have at least one disability.  Most older people live in a family setting.  Some live alone or with friends.  Some live in assisted living residences or nursing centers.  The need for nursing center care increases with aging. Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved. Slide 2

The Older Person (cont’d)  Gerontology is the study of the aging process.  Geriatrics is the care of aging people.  Aging is normal.  Normal changes occur in body structure and function.  Psychological and social changes also occur. Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved. Slide 3

Psychological and Social Changes  Physical reminders of growing old can threaten self-esteem and independence.  Social roles change.  How people cope with aging depends on:  Health status  Life experiences  Finances  Education  Social support systems Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved. Slide 4

Psychological and Social Changes (cont’d)  Retirement is a reward for a lifetime of work.  It often means reduced income.  Social relationships change throughout life.  Children may become caregivers.  Death of a partner is common. Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved. Slide 5

Physical Changes  Physical changes occur with aging.  These happen to everyone.  The rate and degree of change vary with each person.  They depend on diet, health, exercise, stress, environment, heredity, and other factors.  Quality of life does not have to decline. Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved. Slide 6

Physical Changes (cont’d)  The integumentary system  The skin loses its elasticity, strength, and fatty tissue layer.  Secretions from oil and sweat glands decrease.  Blood vessels are fragile.  Brown spots appear on sun-exposed areas.  Loss of the skin’s fatty tissue layer affects body temperature.  Dry skin causes itching and skin is easily damaged. Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved. Slide 7

Physical Changes (cont’d)  Nails become thick and tough.  Feet usually have poor circulation.  The skin has fewer nerve endings.  White or gray hair is common.  Hair loss occurs in men.  Hair thins on men and women.  Facial hair may occur in women.  Hair is drier from decreases in scalp oils.  Skin disorders increase with age. Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved. Slide 8

Physical Changes (cont’d)  The musculo-skeletal system  Muscle cells decrease in number.  Muscles atrophy (shrink) and decrease in strength.  Bones lose minerals, especially calcium.  Bones lose strength, become brittle, and break easily.  Vertebrae shorten.  Joints become stiff and painful.  Mobility decreases.  Activity, exercise, and diet help prevent bone loss and loss of muscle strength. Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved. Slide 9

 The nervous system  Nerve cells are lost.  Nerve conduction and reflexes slow.  Blood flow to the brain is reduced.  Changes occur in brain cells.  Sleep patterns change.  Touch and sensitivity to pain and pressure are reduced.  Taste and smell dull. Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved. Physical Changes (cont’d) Slide 10

 Changes occur in the eye.  Eyelids thin and wrinkle.  Tear secretion is less.  The pupil becomes smaller and responds less to light.  Clear vision is reduced.  The lens of the eye yellows.  Older persons become more farsighted (presbyopia).  Changes occur in the ear.  Changes occur in the acoustic nerve.  Eardrums atrophy.  Wax secretion decreases.  Wax becomes harder and thicker. Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved. Physical Changes (cont’d) Slide 11

 The circulatory system  The heart muscle weakens.  Arteries narrow and are less elastic.  Sometimes circulatory changes are severe. Rest is needed during the day. Rest is needed during the day. Overexertion is avoided. Overexertion is avoided.  The respiratory system  Respiratory muscles weaken.  Lung tissue becomes less elastic.  The person may lack strength to cough and clear the airway of secretions. Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved. Physical Changes (cont’d) Slide 12

 The digestive system  Salivary glands produce less saliva. Dysphagia is a risk.  Taste and smell dull.  Secretion of digestive juices decreases.  Loss of teeth and ill-fitting dentures cause chewing problems.  Peristalsis decreases.  Fewer calories are needed. Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved. Physical Changes (cont’d) Slide 13

 The urinary system  Kidney function decreases.  The kidneys atrophy.  Blood flow to the kidneys is reduced.  The ureters, bladder, and urethra lose tone and elasticity.  Bladder muscles weaken.  Bladder size decreases.  In men, the prostate gland enlarges.  Urinary tract infections are risks. Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved. Physical Changes (cont’d) Slide 14

 The reproductive system  In men, the hormone testosterone decreases slightly. It affects strength, sperm production, and reproductive tissues. It affects strength, sperm production, and reproductive tissues. An erection takes longer. An erection takes longer. The phase between erection and orgasm is longer. The phase between erection and orgasm is longer. Orgasm is less forceful than when younger. Orgasm is less forceful than when younger. Erections are lost quickly. Erections are lost quickly. The time between erections is longer. The time between erections is longer. Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved. Physical Changes (cont’d) Slide 15

 Menopause occurs in women. Menstruation stops. Menstruation stops. The woman can no longer have children. The woman can no longer have children. Female hormones (estrogen and progesterone) decrease. Female hormones (estrogen and progesterone) decrease. The uterus, vagina, and genitalia atrophy. The uterus, vagina, and genitalia atrophy. Vaginal walls thin and there is vaginal dryness. Vaginal walls thin and there is vaginal dryness. Arousal takes longer. Arousal takes longer. Orgasm is less intense. Orgasm is less intense. The pre-excitement state returns more quickly. The pre-excitement state returns more quickly. Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved. Physical Changes (cont’d) Slide 16

Housing Options  Living with family  Adult day-care centers  Elder cottage housing opportunity (ECHO)  Apartments  Residential hotels  Congregate housing  Senior citizen housing Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved. Slide 17

Housing Options (cont’d)  Home-sharing  Assisted living residences  Board and care homes  Adult foster care  Continuing care retirement communities (CCRCs)  Nursing centers  Hospital long-term care units Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved. Slide 18