JAMES VALLEY VOCATIONAL TECHNICAL CENTER 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 System Changes 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

Slower digestion of food Dysphagia is frequent complaint Less saliva Slower gag reflex Loss of teeth Poor fitting dentures Slower digestion of food indigestion

Decrease sensation of taste 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 Regular trips to bathroom 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

Decrease in Testosterone 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

Advantages of sex in elderly 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 Chronic 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 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.