Chapter 10 Geriatric Care

10:1 Myths on Aging Aging for everyone begins at at birth and ends at death Gerontology: scientific study of aging and the problems of the old Geriatric care: care of the elderly Health care worker must distinguish fact from myth

Myths and Facts Myth: most elderly individuals are cared for in institutions (nursing homes), or long-term care facilities Fact: most older people are living at home, with family, or in retirement communities or facilities (continues)

Myths and Facts (continued) Myth: all elderly people live in poverty Fact: less than 10 percent of people over 65 are living at poverty level Myth: the older generation are unhappy and lonely Fact: many elderly individuals socialize by being involved in charity or volunteer work (continues)

Myths and Facts (continued) Myth: anyone over 65 is old Fact: many elderly are active and productive into their 80s and beyond Myth: elderly people are not able to manage their finances Fact: older people have lots of experience and knowledge (continues)

Myths and Facts (continued) Myth: elderly individuals do not want to work; their goal is to retire Fact: there are many elderly who prefer to work into their 70s and 80s Myth: retired people are bored and have nothing to do with their lives Fact: retirees are busy with hobbies, church, family, and community

Summary There are many myths about aging Needs of elderly individuals vary Even though only 5% of the elderly live in long-term care facilities, this still means that 3 million people will be in these facilities by the year 2020 Recognizing normal changes allows the individual to adapt and cope

10:2 Physical Changes of Aging Physical changes are a normal part of the aging process Rate and degree of change varies Usually related to a decreased function of body systems

Integumentary System Production of new skin cells decreases Sebaceous (oil) and sudoriferous (sweat) glands become less active Circulation to skin decreases Hair loses color; hair loss may occur Methods to adapt and cope with changes Measures to slow or decrease changes

Musculoskeletal System Muscles lose their tone, volume, strength Osteoporosis Arthritis Coping with changes Measures to slow or decrease changes Providing a safe environment

Circulatory System Heart muscle becomes less efficient at pushing blood into the arteries Blood vessels narrow and become less elastic Blood flow may decrease to brain and other vital organs Methods used to adapt and cope with changes

Respiratory System Respiratory muscles become weaker Rib cage becomes more rigid Bronchioles lose elasticity Changes in larynx affect voice Methods to cope with changes Measures to slow or decrease changes

Nervous System Progressive loss of brain cells Senses diminish Nerve endings are less sensitive Methods to adapt and cope Measures to slow or decrease changes

Digestive System Fewer digestive juices and enzymes are produced Muscle action becomes slower; peristalsis decreases Teeth are lost Liver function is reduced Methods that are used to adapt and cope with changes

Urinary System Kidneys decrease in size; not as efficient at producing urine Decreased circulation to kidneys Bladder function weakens Methods to adapt and cope with ongoing changes Measures to slow or decrease changes

Endocrine System Increased production of hormones Decreased production of hormones Measures to slow or decrease changes

Reproductive System Female: vaginal walls thin and secretions decrease; uterus can drop; breasts sag Male: sperm decreases; sexual stimuli is slower; ejaculation takes longer; testes become smaller; seminal fluid becomes thinner and less is produced Measures to cope with changes

Summary Aging causes physical changes in all body systems; rate and degree vary Adapting and coping means fuller enjoyment of life Health care workers need to assess individuals’ needs Tolerance, patience, and empathy are essential

10:3 Psychosocial Changes of Aging Elderly individuals also experience psychological and social changes Some cope well, while others experience extreme frustration and mental distress Health care workers must be aware of this and assess changes and stresses

Work and Retirement Most adults spend a large portion of their days working Retirement is often viewed as an end to the working years Many enjoy retirement Some feel a major sense of loss

Social Relationships Change occurs throughout life In elderly individuals, it may occur more rapidly Some elderly people adjust to changes Some elderly people cannot cope

Living Environments Changes in living environments create psychosocial changes Many elderly people prefer to stay in their own homes Some individuals leave their home by choice Moving to a long-term care facility often creates stress

Independence Most individuals want to be independent and self-sufficient Elderly people learn that independence can be threatened with age Factors that can lead to decreased independence include physical disability, illness, and decreased mental ability (continues)

Independence (continued) Individuals may need assistance, but the health care worker needs to allow the elderly maximum independence and personal choice

Disease and Disability Elderly people are more prone to disease and disability Diseases sometimes cause permanent disabilities When functioning is affected, psychological stress is experienced Sick people often have fear of death, illness, loss of function, and pain

Summary Psychosocial changes can be a major source of stress As changes occur, individuals must learn to accommodate the changes and function in new situations With support, understanding, and patience, workers can assist individuals as they learn to adapt

10:4 Confusion and Disorientation in the Elderly Most remain mentally alert until death Signs of confusion or disorientation It is sometimes a temporary condition Disease and/or damage to the brain

Dementia Term used to describe a loss of mental ability Characteristics include decrease in intellectual ability, loss of memory, and personality change Acute dementia Chronic dementia

Alzheimer’s Disease One form of dementia Causes progressive changes in the brain cells Lack of neurotransmitter Frequently occurs in 60s, but can occur as young as 40 years of age Cause is unknown (continues)

Alzheimer’s Disease (continued) Terminal incurable brain disease; usually lasting 3–10 years Early stage Middle stage Terminal stage

Caring for the Confused or Disoriented Patient Provide safe and secure environment Follow the same routine Follow “reality orientation” guidelines

Summary Caring for a confused or disoriented individual can be frustrating and even frightening at times Perform continual assessments Design program to maximize function Practice patience, consistency, and sincere caring

10:5 Meeting the Needs of the Elderly Geriatric care can be challenging but rewarding Elderly people have the same needs as others Cultural needs Religious needs Freedom from abuse Respect patient’s rights

Summary Needs of the elderly do not vary that much from needs of others Sensitive to individual cultural and religious differences Important to respect and follow all of the patient’s rights Must ensure that the patient is free from abuse