1. JAMES VALLEY VOCATIONAL TECHNICAL CENTER
Geriatric Care
JAMES VALLEY VOCATIONAL TECHNICAL CENTER

2. 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

3. Older people are lonely and unhappy
Elderly do not want to work
“Old Age” begins a 65
Retirement ends your active life

4. 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.

5. 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

6. Integumentary System Changes
Production of new skin cells decreases
Oil and Sweat glands become less active
Circulation decreases

7. 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)

8. Fatty tissue layer of skin diminishes
Lines and wrinkles appear
Nails become thick, tough, and brittle
Increased sensitivity to temperature

9. Care of Skin Use mild soap Bath oils or lanolin lotion
Bath or Shower once or twice a week
Brush Hair daily

10. 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

11. Circulatory System Changes
Loss of pacemaker cells:
-Slightly slower heart rate/abnormal rhythms
Heart muscle becomes more rigid
-HR and cardiac output diminished

12. Circulatory System Changes
Decreased parasympathetic system:
-HR more prone to increase
Decreased baroreceptors that monitor the blood pressure
Increased dizziness

13. Circulatory System Changes
Decreased elasticity of blood vessels
-Increased blood pressure
Thicker capillary walls
Decreased nutrient/waste exchange

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

15. Circulatory System Care
With circulatory changes:
Avoid strenuous exercise or over exertion
Periods of rest
Moderate exercise, according to individual’s tolerance

16. 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
Range Of Motion exercises

17. High Blood Pressure = Diet low in salt Decrease fat intake
Exercise as recommended by physician

18. Respiratory Changes Respiratory muscles become weaker
Rib cage more rigid
Alveoli thinner & less elastic which decreases exchange of gases - emphysema

19. 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

20. 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

21. Respiratory Care Alternate activity with periods of rest
Proper body alignment & positioning
Sleep in semi-fowlers position
Use 2 or 3 pillows

22. Respiratory Care

23. Avoid polluted air
Breath deeply & cough frequently
May need continuous oxygen therapy: tanks vs. concentrators

24. Nervous System Changes
Blood flow to brain decreases & there is a progressive loss of brain cells - - Interferes with
Thinking - Reacting
Interpreting - Remembering

25. 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

26. 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

29. Changes in hearing Hearing loss usually gradual
Person may speak louder than usual
Ask for words to be repeated
Not able to hear high frequency sounds
May not hear well in crowded places

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

31. Nervous System Care
Mental and physical exercise can help your brain stay sharp. Mental exercises include:
Reading
Doing crossword puzzles
Stimulating conversation
Physical exercise promotes blood flow to your brain. It also helps reduce loss of brain cells.

32. Nervous System Care Glasses Hearing Aids
Minimize crowds….less background noise
Speak slower and facing the individual
Medications and gum disease may influence sense of taste…

33. Digestive Changes Fewer digestive juices and enzymes produced
Muscle action becomes slower & peristalsis decreases
Teeth are lost
Liver function decreases

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

35. Decrease sensation of taste
Decrease peristalsis
Increase flatulence (gas)
Constipation
Decrease sensation of taste
Poor appetite
Poor diet

36. 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

37. Urinary Changes Kidneys decrease in size & become less efficient
Bladder becomes less efficient
May not hold as much
May not empty completely
Incontinence

38. Urinary Care Increase fluid intake Regular trips to bathroom
Decrease before bedtime
Regular trips to bathroom
Easy to remove clothing
Absorbent pads

39. Endocrine Changes
Increased production of some hormones and decreased of others- Estrogen (in women), Testosterone (in men), Growth hormone, Melatonin
Immune system less effective
BMR decreases
Intolerance to glucose

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

41. Reproductive System Changes
Decrease of estrogen / progesterone in female
Thinning of vaginal wall
Decrease vaginal secretions
Inflammation of vagina common

42. 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

43. 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

44. 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

45. Psychocosocial Changes
Some individuals cope with psychosocial changes, and others experience extreme frustration and mental distress

46. Fears of a sick person:
Death
Chronic illness
Loss of function
Pain

47. Dealing with fears created by an illness:
Listening
Patience
Understanding
Provide support

48. Confusion and Disorientation
Six signs:
Talking incoherently
Not knowing their name
Not recognizing others
Wandering aimlessly
Lacking awareness of time or place

49. Displaying hostile and combative behavior
Hallucinating
Regressing in behavior
Paying less attention to personal hygiene
Inability to respond to simple commands or instructions

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

51. Diseases: CVA: cerebrovascular accident Arteriosclerosis
Atherosclerosis
Cause TIA’s (transient eschemic attacks) = ministrokes which result in temporary periods of diminished blood flow to the brain.

52. Dementia
Loss of mental ability characterized by a decrease in intellectual ability, loss of memory, impaired judgement, personality change, and disorientation

53. 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

54. Alzheimer’s Disease
Form of dementia that causes progressive changes in brain cells

55. Early Stages: Memory loss Mood & personality changes Depression
Poor judgment
Confusion regarding time & place
Inability to plan and follow through with ADLs

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

57. Late Stages: Total disorientation Incoherent
Unable to communicate with words
Loses control of bladder & bowel functions

58. Develops seizures
Loses weight despite eating a balanced diet
Becomes totally dependent
Lapses into a coma
Dies

59. 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.

60. 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)

61. 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.

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

63. 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

64. 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

65. Do not hesitate to touch communicate with person
Avoid arguments
Encourage independence and self help whenever possible

66. Meeting the Elderly Needs
Culture: the values, beliefs, ideas, customs, and characteristics that are passed from one generation to the next.

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

68. 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.

69. 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

70. Abuse
Physical
Verbal
Psychological
Sexual

71. Report any abuse observed to proper agency
Reasons elderly do not report abuse
Feel they deserve the abuse
Want to protect abuser

72. 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.