Geriatric Care Chapter 10

Objectives Differentiate between the myths and facts of six aspects of aging. Identify at least two physical changes of aging in each body system. Demonstrate at least 10 methods of providing care to the elderly individual who is experiencing physical changes of aging. List 5 factors that cause psychological changes of aging. Describe at least 6 methods to assist an elderly individual in adjusting to psychosocial changes. Recognize the causes and effects of confusion and disorientation in the elderly. Create a reality orientation program. Justify the importance of respecting cultural and religious differences. Explain the role of an ombudsman. Define, pronounce, and spell all key terms.

Physical Changes of Aging Normal part of the aging process – gradual, takes place over long period of time Factors that affect aging: Disease Lifestyle Nutrition Economic status Social environment Limited access to medical care Decrease in function of body systems Processes slow down Decrease in energy level

Integumentary System Production of new skin cells decreases Sebaceous (oil) and sudoriferous (sweat) glands become less active Circulation to skin decreases Causes coldness, dryness, and poor healing of injured tissue Hair loses color; hair loss may occur Dark yellow or brown colored spots appear  senile lentigines Lines and wrinkles develop when fatty tissue layer diminishes Nails become thick and brittle

Senile lentigines

Integumentary System Mild soaps should be used to prevent dryness Oils and moisturizing lotions to combat dryness and itching Bath or shower only two or three times per week Brushing hair stimulates circulation and production of oil Shampoo less often to prevent dry, breaking hair Sores or injuries to be cared for immediately! Important to prevent infection because the elderly heal slowly Room temperature higher than normal

Musculoskeletal System Aging  Muscles lose their tone, volume, strength Osteoporosis – a condition in which calcium is lost from the bones, causing them to be brittle and more prone to fractures Arthritis – inflammation of the joints causing them to be stiff, less flexible, and painful Loss in height, decreased mobility, general weakness Movement is slower, sense of balance is decreased Falls occur easily and breaks are serious!

Musculoskeletal System Encourage exercise  keeps muscles active and joints flexible Slow, daily walks Range of motion exercises Diet rich in protein, calcium, vitamins slows mineral loss Attention to environment Grab bars in bathrooms, hand rails on stairs Use of walkers, canes, well fitting shoes with non-slip soles to prevent falls

Circulatory System Heart muscle becomes less efficient at pumping blood through arteries Cardiac output decreases Blood vessels become narrow and less elastic Blood pressure problems! Blood flow may decrease to brain and other vital organs Experience weakness, dizziness, numbness in hands/feet, and rapid heart rate

Circulatory System Avoid strenuous exercise or overexertion Periods of rest during the day Moderate exercise stimulates circulation and helps prevent formation of thrombus (blood clot) Support stockings helps prevent thrombus Avoid garters and tight bands around legs If confined to bed or wheelchair, range of motion exercises are crucial! High blood pressure  low sodium diet

Respiratory System Respiratory muscles become weaker with age. Rib cage becomes more rigid. Alveoli (air sacs in lungs) become thinner and less elastic Decreases oxygen exchange Bronchioles (air tubes in lungs) lose elasticity Changes in larynx  higher pitch, weaker voice Dyspnea – difficulty breathing Rapid breaths Difficulty coughing up secretions More susceptible to lung infections

Emphysema Bronchitis

Respiratory System Alternate activity with rest periods to avoid dyspnea Proper body alignment Sleeping elevated with pillows Avoid polluted air (smoke filled rooms) Deep breathing and coughing to keep lungs clear and improve elasticity Supplemental oxygen via cannula as needed

Nervous System Blood flow to brain decreases  Progressive loss of brain cells Interferes with thinking, reacting, interpreting, and remembering Senses diminish Nerve endings less sensitive  decreased response to pain Memory loss – usually short term memory Changes in vision Problems seeing small print or far away objects Decreased peripheral vision and night vision Prone to cataracts and glaucoma

Nervous System Changes in Hearing Changes in Taste and Smell Occurs gradually May speak more loudly, ask for words to be repeated, and not hear high pitches like phone ringing Hearing aids cannot improve hearing if there is nerve damage to ears Changes in Taste and Smell Often complain food is tasteless Less sensitive to smell of gas, chemicals, smoke, etc. Decreased sensation of pain leads to injuries

Digestive System Fewer digestive juices and enzymes are produced Muscle action becomes slower Peristalsis decreases, teeth are lost, live function decreases Less saliva and slower gag reflex  Dysphagia (difficulty swallowing) Less saliva and slower gag reflex Indigestion results from slower digestion Flatulence (gas) is common because of decreased peristalsis

Digestive System Good oral hygiene, repair/replace damaged teeth Contribute to better chewing and digestion Avoid dry, fried, fatty foods – difficult to chew/digest High-fiber, high-protein foods are recommended Use of seasoning to improve taste and increase appetite Be careful to avoid over-seasoning due to indigestion Increase fluid intake Helps swallowing, prevents constipation, aids kidney function

Urinary System Kidneys decrease in size, become less efficient at producing urine Poor circulation to kidneys  loss of ability to concentrate urine  loss of electrolytes and fluids Ability of bladder to hold urine decreases Urine retention  bladder infections (UTIs) Nocturia – urination at night – is common, disrupts sleep patterns Men – enlargement of prostate gland makes urinating difficult Incontinence – inability to control urination

Urinary System Many elderly people decrease fluid intake to cut down on trips to bathroom  dehydration, kidney disease, infection Increase fluid intake to improve kidney function! Before evening time to prevent nocturia Regular trips to bathroom Easy to remove clothing Absorbent pads for incontinence Bladder training programs to increase bladder capacity and control in incontinent persons

Endocrine System Increased production of hormones Parathormone Thyroid-stimulating hormone Decreased production of hormones Thyroxin Estrogen Progesterone Insulin Immune system is less effective – more prone to disease Basal metabolic rate decreases – feel cold, tired, less alert Intolerance to glucose can develop – increased blood glucose levels

Endocrine System Changes are subtle and occur gradually over time Most elderly do not even realize these changes are occurring Proper exercise, rest, medical care for illness, diet, and healthy lifestyle all help decrease effects caused by changes in hormone activity

Reproductive System Female – decrease of estrogen and progesterone vaginal walls thin, decrease in vaginal secretions, uterus drops, breasts sag Male – decrease of testosterone slowed production of sperm, sexual stimulation of penis is slower, ejaculation takes longer, testes become smaller

Summary Aging causes physical changes in ALL body systems. Rate and degree of changes varies based on each individual. Adapting and coping with the changes allows the elderly to enjoy life even with physical limitations. Health care workers must recognize changes and provide methods for dealing with them. Tolerance, patient, and empathy are essential.