1. Geriatric Care
Chapter 10

2. 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.

3. 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

4. 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

5. Senile lentigines

6. 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

7. 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!

9. 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

10. 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

11. 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

13. 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

14. Emphysema
Bronchitis

15. 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

16. 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

18. 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

19. 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

21. 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

22. 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

23. 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

24. 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

25. 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

26. 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

27. 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.