1. Chapter 11
The Older Person

2. People live longer than ever before.
Most older persons have at least one disability.
Disabilities increase and become more severe with aging.
Most older people live in a family setting.
The U.S. Government reports shows that the number of elderly persons in the U.S. is growing rapidly.
Widow-hood is more common in older women than in older men.
Chronic illness is common in older persons. Disability often results. Most older persons have at least one disability.
Disabilities can interfere with activities of daily living.
The need for nursing center care increases with aging.

3. Growth and Development
Throughout life, people grow and develop.
Growth and development occur in a sequence, order, and pattern.
Certain skills must be completed during each stage.
A stage cannot be skipped.
Each stage is the basis for the next stage.
Late adulthood involves these age ranges:
Young-old: between 65 and 74 years of age
Old: between 75 and 84 years of age
Old-old: 85 years of age and older
Growth is the physical changes that are measured and that occur in a steady, orderly manner. Growth is measured in height and weight. Changes in appearance and body functions also measure growth.
Development relates to changes in mental, emotional, and social function.
Growth and development occur in a sequence, order, and pattern. Certain skills must be acquired during each stage.
A developmental task is a skill that must be acquired during a stage of development.
Review Box 10-1 on p. 116 in the textbook.

4. Gerontology is the study of the aging process.
Geriatrics is the care of aging people.
Aging is normal.
There are many myths about aging and older persons.
A myth is a widely believed story that is not true.
Aging is not a disease. Normal changes occur in body structure and function. They increase the risk for illness, injury, and disability. Psychological and social changes also occur.
To provide good care, you need to know the facts about older persons and aging.
Review Box 10-2 on p. 116 in the textbook.

5. Psychological and Social Changes
How people cope with aging depends on:
Health status
Life experiences
Finances
Education
Social support systems
Retirement
Retirement is a reward for a lifetime of work.
Work helps meet love, belonging, and self-esteem needs.
Retirement usually means reduced income.
Physical reminders of growing old affect self-esteem. They threaten self-image and feelings of self-worth. They also threaten independence.
Social roles also change. A parent may depend on an adult child for care. Adjusting to the death of a partner, family members, and friends is common. The person faces his or her own death.

6. Children as caregivers
Social relationships
Social relationships change throughout life.
Most older people have regular contact with children, grandchildren, family, and friends.
Some older persons are lonely.
Children as caregivers
Some children care for older parents.
Parents and children change roles.
Death of a partner
Women usually live longer than men.
When death occurs, the loss is crushing.
The person loses a lover, friend, companion, and confidant.
Many older people adjust to social changes.
The social changes of aging can cause loneliness.
Review Focus on Communication: Social Changes on p. 118 in the textbook.
Grief may be very great after death of a partner. Serious physical and mental health problems may result.

7. Physical Changes Physical changes occur with aging.
Energy level and body efficiency decline.
The changes occur over many years.
The rate and degree of change vary with each person.
Quality of life does not have to decline.
The rate and degree of change vary with each person. They depend on such factors as diet, health, exercise, stress, environment, and heredity.
Normal aging does not mean loss of health. The person can adjust to many of the changes.
Review Box 10-3 on p. 119 in the textbook.

8. The integumentary system
The skin loses its elasticity, strength, and fatty tissue layer.
Secretions from oil and sweat glands decrease.
Blood vessels decrease in number.
Brown spots appear on the skin.
Loss of the skin’s fatty tissue layer makes the person more sensitive to cold.
Dry skin is easily damaged and causes itching.
Bruising and delayed healing are risks, as well as skin breakdown, skin tears, and pressure ulcers.
Brushing hair promotes circulation and oil production.
What are some steps you can take to help the resident who is cold or has dry skin?

9. Nails become thick and tough. The skin has fewer nerve endings.
Older persons often complain of cold feet.
White or gray hair is common.
Hair loss occurs in men.
Hair is drier from decreases in scalp oils.
Skin disorders increase with age.
Fragile skin, poor circulation, and decreased ability to sense heat and cold increase the risk of burns.
A nick or cut on the feet can lead to a serious infection.

10. The musculoskeletal system
Muscle cells decrease in number.
Muscles atrophy (shrink).
Muscles decrease in strength.
Bones lose minerals, especially calcium.
Bones lose strength.
Bones become brittle and break easily.
Activity, exercise, and diet help prevent bone loss and loss of muscle strength.
Even the elderly can increase the strength of their muscles through activity.
Exercise groups and range-of-motion exercises are helpful.
You need to protect the person from injury and prevent falls, turn and move the person gently and carefully, help the person get out of bed as needed, and help the person walk as needed.
Although mobility may be decreased and joints may be sore, there are many benefits of activity and exercise!

11. The nervous system Nerve cells are lost.
Nerve conduction and reflexes are slow.
Responses are slower.
Blood flow to the brain is reduced.
There is loss of brain cells over time and reduced blood flow to the brain.
This affects personality and mental function.
Memory is shorter.
Forgetfulness increases.
Responses slow.
Confusion, dizziness, and fatigue may occur.
Review Box 10-3 on p. 119 in the textbook.

12. Many older people are mentally active and involved in current events.
They show fewer personality and mental changes.
Sleep patterns change.
The senses
Touch and sensitivity to pain and pressure and heat and cold are reduced.
Taste and smell dull.
There are changes in the eye.
Changes occur in the ear.
Presbyopia is farsightedness. The lens becomes more rigid with age.
To gain an appreciation of how much more difficult life is for the elderly, try this experiment: Wear plastic goggles smeared with Vaseline (in front and on the sides) to impede your vision, and put cotton in your ears to decrease your hearing. If you want to experience decreased mobility as well, tie your ankles together loosely and require yourself to use a walker. See how long you can last without getting frustrated!

13. The circulatory system
The heart muscle weakens.
It pumps blood with less force.
Arteries narrow and are less elastic.
Poor circulation occurs in many body parts.
When circulatory changes are severe:
Rest is needed during the day.
Overexertion is avoided.
Personal care items and other needed items are kept nearby.
Exercise helps maintain health and well-being. Many older persons exercise daily. Older persons need to be as active as possible.
However, a damaged or weak heart may not be able to meet the increased oxygen and nutrient needs of activity, exercise, excitement, or illness.
Even when circulatory changes are severe, some exercise helps circulation. Doctors may order certain exercises and activity limits.

14. The respiratory system
Respiratory muscles weaken.
Lung tissue becomes less elastic.
Dyspnea may occur with activity.
The person may lack strength to cough and clear the airway of secretions.
Respiratory infections and diseases may develop.
The person should be as active as possible.
Difficult, labored, or painful breathing (dyspnea) may occur with activity. (Dys- means difficult. -pnea means breathing.)
Normal breathing is promoted.

15. The digestive system Salivary glands produce less saliva.
This can cause dysphagia (difficulty swallowing).
Secretion of digestive juices decreases.
Loss of teeth and ill-fitting dentures can cause chewing problems.
Peristalsis decreases.
Flatulence and constipation can occur.
These measures can help:
Avoid dry, fried, and fatty foods.
Eat high fiber foods.
Eat foods that provide soft bulk.
More fluids are needed for chewing, swallowing, digestion, and kidney function.
Foods are needed to prevent constipation and bone changes.
If the nurse allows, encourage residents to drink water to help their digestion.
Oral hygiene and denture care improve taste.

16. The urinary system Kidney function decreases.
The kidneys shrink (atrophy).
Blood flow to the kidneys is reduced.
The ureters, bladder, and urethra lose tone and elasticity.
Bladder muscles weaken.
Bladder size decreases.
Urinary tract infections are risks.
Waste removal is less efficient. Urine is more concentrated.
Urinary frequency or urgency may occur. Many older persons have to urinate during the night. Urinary incontinence (inability to control the passage of urine from the bladder) may occur.
In men, the prostate gland enlarges. Difficulty urinating or frequent urination occurs.
Taking most fluids before 1700 (5:00 p.m.) reduces the need to urinate during the night.
Adequate fluids are needed. The person needs water, juices, milk, and gelatin. Provide fluids according to the care plan.

17. Changes in the reproductive organs occur in men.
The hormone testosterone decreases.
Changes affect strength, sperm production, and reproductive tissues.
Changes in the reproductive organs occur in women.
Menopause is when menstruation stops and the woman can no longer have children.
Female hormones (estrogen and progesterone) decrease.
Reproductive organs change with aging in men and women.
For the effects of aging on sexuality, see Chapter 11 in the textbook.

18. Housing Options for Older People
Living with family
Adult day-care centers
Elder Cottage Housing
Apartments, accessory dwelling units (ADU)
Residential hotels
Congregate housing
Senior citizen housing
Home-sharing
Assisted living
Board and care homes
Adult foster care
Continuing care retirement communities (CCRCs)
Nursing centers
What are the advantages and disadvantages of each type of housing for older people? [Discuss each.] Some center designs, programs, and services follow the Eden Alternative. Animals, plants, and children play a key role in giving residents dignity and purpose. “Household”, “neighborhood”, and “community” are other nursing center models and designs.
Most nursing centers receive Medicare or Medicaid funds. They must meet requirements of the Omnibus Budget Reconciliation Act of 1987 (OBRA). The Centers for Medicare & Medicaid Services (CMS), a federal agency, has rules and regulations for OBRA.
Review Box 10-4 on p. 125 in the textbook.

19. Environmental Requirements
The person’s care equipment is clean and properly stored.
Bed linens are clean and in good condition.
There are clean towels and wash cloths for each person.
The person has closet space with reachable shelves.
Lighting, temperature, and sound levels are comfortable and adequate.
Hand rails, assistive devices, and other surfaces are in good repair.
Care equipment is used following the manufacturer’s instructions.
Safety measures are practiced.
Review Box 10-5 on p. 126 in the textbook.

20. Quality of Life
Moving to a nursing center can cause feelings of loneliness and isolation.
Some people are trying to cope with many losses.
These measures can help the person feel good about his or her appearance:
Help residents with grooming.
Help them dress in clothes of their choice.
Make sure dentures, eyeglasses, and hearing aids are in place.
Respect the person’s wishes for privacy.
Some residents cannot visit with friends or get to activities without help. Offer to take them to visit in a friend’s room or to an activity.
What are other ways you can help older persons adjust to life in a nursing center?